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March 25, 1988, Vol 259, No. 12 >
ARTICLE | March 25, 1988

Risk Factors for Ectopic Pregnancy: Title and subTitle BreakA Population-Based Study FREE

Polly A. Marchbanks, PhD; John F. Annegers, PhD; Carolyn B. Coulam, MD; Janette H. Strathy, MD; Leonard T. Kurland, MD, DrPH
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JAMA. 1988;259(12):1823-1827. doi:10.1001/jama.1988.03720120027030
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References

To evaluate the association between ectopic pregnancy and 22 potential risk factors, we conducted a population-based case-control study. The investigation included 274 cases diagnosed from 1935 through 1982 in residents of Rochester, Minn, and 548 matched controls selected from live-birth deliveries. Risk factor information documented prior to the last index menstrual period was obtained via medical record abstract. Univariate matched analyses revealed nine variables associated with a significantly elevated relative risk of ectopic pregnancy. Following conditional logistic regression, four variables remained as strong and independent risk factors for ectopic pregnancy: current intrauterine device use (relative risk, 13.7; 95% confidence interval, 1.6 to 120.6), a history of infertility (relative risk, 2.6; 95% confidence interval, 1.6 to 4.2), a history of pelvic inflammatory disease (relative risk, 3.3; 95% confidence interval, 1.6 to 6.6), and prior tubal surgery (relative risk, 4.5; 95% confidence interval, 1.5 to 13.9). Theoretically, any condition that prevents or retards migration of the fertilized ovum to the uterus could predispose a woman to ectopic gestation. Further research is needed to clarify the impact of other potential risk factors in the etiology of ectopic pregnancy.

(JAMA 1988;259:1823-1827)

REFERENCES

1 +
 Ectopic pregnancy—United States, 1981-1983. MMWR 1986;;35:289-291.
2 +
Strathy JH, Coulam CB, Marchbanks PA, et al:  Incidence of ectopic pregnancy in Rochester, Minnesota, 1950-1981. Obstet Gynecol 1984;;64:37-43.
3 +
Beral V:  An epidemiological study of recent trends in ectopic pregnancy. Br J Obstet Gynaecol 1975;;82:775-782.
4 +
Erkkola R, Liukko P:  Intrauterine device and ectopic pregnancy. Contraception 1977;;16:569-574.
5 +
Westrom L, Bengtsson LPH, Mardh P-A:  Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J 1981;;282:15-18.
6 +
DeCherney AH:  Ectopic pregnancy , in Kase NG, Weingold AB (eds): Principles and Practice of Clinical Gynecology . New York, John Wiley & Sons Inc, 1983;, pp 483-487.
7 +
Schneider J, Berger CJ, Cattell C:  Maternal mortality due to ectopic pregnancy: A review of 102 deaths. Obstet Gynecol 1977;;49:557-561.
8 +
Pauerstein CJ: The Fallopian Tube: A Reappraisal . Philadelphia, Lea & Febiger, 1974;.
9 +
Schoen JA, Nowak RJ:  Repeat ectopic pregnancy: A 16-year clinical survey. Obstet Gynecol 1975;;45:542-546.
10 +
Crawford E, Hutchinson H:  A decade of reports on tubal pregnancies condensed from the literature plus 300 consecutive cases without a death. Am J Obstet Gynecol 1954;;67:568-584.
11 +
Malkasian GD Jr, Hunter JS Jr, ReMine WH:  Ectopic pregnancy: Analysis of 322 consecutive cases, 1935-1954. JAMA 1958;;168:985-990.
12 +
Franklin EW III, Zeiderman AM:  Tubal ectopic pregnancy: Etiology and obstetric and gynecologic sequelae. Am J Obstet Gynecol 1973;;117:220-225.
13 +
Hallatt JG:  Repeat ectopic pregnancy: A study of 123 consecutive cases. Am J Obstet Gynecol 1975;;122:520-524.
14 +
Kallenberger DA, Ronk DA, Jimerson GK:  Ectopic pregnancy: A 15-year review of 160 cases. South Med J 1978;;71:758-763.
15 +
Nagamani M, London S, St Amand P:  Factors influencing fertility after ectopic pregnancy. Am J Obstet Gynecol 1984;;149:533-535.
16 +
Kurland LT:  The Rochester epidemiology program project , in Lawrence RC, Shulman LE (eds): Epidemiology of the Rheumatic Diseases . New York, Gower Medical Publishing, 1984;, pp 359-363.
17 +
Kurland LT, Molgaard CA, Schoenberg BS:  Mayo Clinic records-linkage: Contributions to neuroepidemiology. Neuroepidemiology 1982;;1: 102-114.
18 +
Hospital Adaptation of ICDA . Ann Arbor, Mich, Commission on Professional and Hospital Activities, 1973;.
19 +
Miettinen OS:  Estimation of relative risk from individually matched series. Biometrics 1970;;26: 75-86.
20 +
Kleinbaum DG, Kupper LL, Morgenstern H: Epidemiologic Research . Belmont, Calif, Lifetime Learning Publications, 1982;.
21 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 1959;;22:719-748.
22 +
Breslow NE, Day NE:  The Analysis of Case-Control Studies , vol 1, in Statistical Methods in Cancer Research . Lyons, France, International Agency for Research on Cancer, 1980;.
23 +
Westrom L:  Effect of acute pelvic inflammatory disease on fertility. Am J Obstet Gynecol 1975;;121:707-713.
24 +
World Health Organization's Special Programme of Research, Development and Research Training in Human Reproduction:  A multinational case-control study of ectopic pregnancy. Clin Reprod Fertil 1985;;3:131-143.
25 +
Levin AA, Schoenbaum SC, Stubblefield PG, et al:  Ectopic pregnancy and prior induced abortion. Am J Public Health 1982;;72:253-256.
26 +
Tatum HJ, Schmidt FH:  Contraceptive and sterilization practices and extrauterine pregnancy: A realistic perspective. Fertil Steril 1977;;28:407-421.
27 +
Berger GS, Keith LG, Edelman DA:  IUDs and ectopic pregnancies , in Hafez ESE, vanOs WAA (eds): IUD Pathology and Management . Boston, Hall Medical Publishers, 1980;, pp 169-177.
28 +
Edelman DA, Berger GS, Keith L: Intrauterine Devices and Their Complications . Boston, Hall Medical Publishers, 1979;.
29 +
Ory HW, The Women's Health Study:  Ectopic pregnancy and intrauterine contraceptive devices: New perspectives. Obstet Gynecol 1981;;57:137-144.
30 +
Chow WH, Daling JR, Weiss NS, et al:  IUD use and subsequent tubal ectopic pregnancy. Am J Public Health 1986;;76:536-539.
31 +
DeStefano F, Peterson HB:  Ectopic pregnancy after sterilization. JAMA 1984;;251:1432.
32 +
McCausland AM:  High rate of ectopic pregnancy following laparoscopic tubal coagulation failures. Am J Obstet Gynecol 1980;;136:97-101.
33 +
DeStefano F, Peterson HB, Layde PM, et al:  Risk of ectopic pregnancy following tubal sterilization. Obstet Gynecol 1982;;60:326-330.
34 +
Chung CS, Smith RG, Steinhoff PG, et al:  Induced abortion and ectopic pregnancy in subsequent pregnancies. Am J Epidemiol 1982;;115:879-887.
35 +
Daling JR, Chow WH, Weiss NS, et al:  Ectopic pregnancy in relation to previous induced abortion. JAMA 1985;;253:1005-1008.
36 +
Panayotou PP, Kaskarelis DB, Miettinen OS, et al:  Induced abortion and ectopic pregnancy. Am J Obstet Gynecol 1972;;114:507-510.
37 +
Bender S:  The end-results in primary sterility. Br Med J 1952;;2:409-413.
38 +
Wyper JF B:  Pregnancy after primary infertility investigation. Br Med J 1962;;1:273-276.
39 +
Karow WG, Payne SA:  Pregnancy after clomiphene citrate treatment. Fertil Steril 1968;;19:351-362.
40 +
MacGregor AH, Johnson JE, Bunde CA:  Further clinical experience with clomiphene citrate. Fertil Steril 1968;;19:616-622.
41 +
Weiss DB, Aboulafia Y:  Ectopic gestation and hydatidiform mole in clomiphene-induced pregnancies. Lancet 1975;;2:1094-1095.
42 +
Marchbanks PA, Coulam CB, Annegers JF:  Clomiphene citrate and ectopic pregnancy. Fertil Steril 1986;;45:307-308.
43 +
Marchbanks PA, Coulam CB, Annegers JF:  An association between clomiphene citrate and ectopic pregnancy: A preliminary report. Fertil Steril 1985;;44:268-270.
44 +
Corson SL, Batzer FR:  Clomiphene citrate and ectopic pregnancy. Fertil Steril 1986;;45:307.
45 +
Weiss NS, Daling JR, Chow WH:  Control definition in case-control studies of ectopic pregnancy. Am J Public Health 1985;;75:67-68.
46 +
Hawkins DF, Elder MG: Human Fertility Control: Theory and Practice . Woburn, Mass, Butterworths, 1979;.
47 +
Chow WH, Daling JR, Weiss NS, et al:  Vaginal douching as a potential risk factor for tubal ectopic pregnancy. Am J Obstet Gynecol 1985;;153:727-729.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
 Ectopic pregnancy—United States, 1981-1983. MMWR 1986;;35:289-291.
2 +
Strathy JH, Coulam CB, Marchbanks PA, et al:  Incidence of ectopic pregnancy in Rochester, Minnesota, 1950-1981. Obstet Gynecol 1984;;64:37-43.
3 +
Beral V:  An epidemiological study of recent trends in ectopic pregnancy. Br J Obstet Gynaecol 1975;;82:775-782.
4 +
Erkkola R, Liukko P:  Intrauterine device and ectopic pregnancy. Contraception 1977;;16:569-574.
5 +
Westrom L, Bengtsson LPH, Mardh P-A:  Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J 1981;;282:15-18.
6 +
DeCherney AH:  Ectopic pregnancy , in Kase NG, Weingold AB (eds): Principles and Practice of Clinical Gynecology . New York, John Wiley & Sons Inc, 1983;, pp 483-487.
7 +
Schneider J, Berger CJ, Cattell C:  Maternal mortality due to ectopic pregnancy: A review of 102 deaths. Obstet Gynecol 1977;;49:557-561.
8 +
Pauerstein CJ: The Fallopian Tube: A Reappraisal . Philadelphia, Lea & Febiger, 1974;.
9 +
Schoen JA, Nowak RJ:  Repeat ectopic pregnancy: A 16-year clinical survey. Obstet Gynecol 1975;;45:542-546.
10 +
Crawford E, Hutchinson H:  A decade of reports on tubal pregnancies condensed from the literature plus 300 consecutive cases without a death. Am J Obstet Gynecol 1954;;67:568-584.
11 +
Malkasian GD Jr, Hunter JS Jr, ReMine WH:  Ectopic pregnancy: Analysis of 322 consecutive cases, 1935-1954. JAMA 1958;;168:985-990.
12 +
Franklin EW III, Zeiderman AM:  Tubal ectopic pregnancy: Etiology and obstetric and gynecologic sequelae. Am J Obstet Gynecol 1973;;117:220-225.
13 +
Hallatt JG:  Repeat ectopic pregnancy: A study of 123 consecutive cases. Am J Obstet Gynecol 1975;;122:520-524.
14 +
Kallenberger DA, Ronk DA, Jimerson GK:  Ectopic pregnancy: A 15-year review of 160 cases. South Med J 1978;;71:758-763.
15 +
Nagamani M, London S, St Amand P:  Factors influencing fertility after ectopic pregnancy. Am J Obstet Gynecol 1984;;149:533-535.
16 +
Kurland LT:  The Rochester epidemiology program project , in Lawrence RC, Shulman LE (eds): Epidemiology of the Rheumatic Diseases . New York, Gower Medical Publishing, 1984;, pp 359-363.
17 +
Kurland LT, Molgaard CA, Schoenberg BS:  Mayo Clinic records-linkage: Contributions to neuroepidemiology. Neuroepidemiology 1982;;1: 102-114.
18 +
Hospital Adaptation of ICDA . Ann Arbor, Mich, Commission on Professional and Hospital Activities, 1973;.
19 +
Miettinen OS:  Estimation of relative risk from individually matched series. Biometrics 1970;;26: 75-86.
20 +
Kleinbaum DG, Kupper LL, Morgenstern H: Epidemiologic Research . Belmont, Calif, Lifetime Learning Publications, 1982;.
21 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 1959;;22:719-748.
22 +
Breslow NE, Day NE:  The Analysis of Case-Control Studies , vol 1, in Statistical Methods in Cancer Research . Lyons, France, International Agency for Research on Cancer, 1980;.
23 +
Westrom L:  Effect of acute pelvic inflammatory disease on fertility. Am J Obstet Gynecol 1975;;121:707-713.
24 +
World Health Organization's Special Programme of Research, Development and Research Training in Human Reproduction:  A multinational case-control study of ectopic pregnancy. Clin Reprod Fertil 1985;;3:131-143.
25 +
Levin AA, Schoenbaum SC, Stubblefield PG, et al:  Ectopic pregnancy and prior induced abortion. Am J Public Health 1982;;72:253-256.
26 +
Tatum HJ, Schmidt FH:  Contraceptive and sterilization practices and extrauterine pregnancy: A realistic perspective. Fertil Steril 1977;;28:407-421.
27 +
Berger GS, Keith LG, Edelman DA:  IUDs and ectopic pregnancies , in Hafez ESE, vanOs WAA (eds): IUD Pathology and Management . Boston, Hall Medical Publishers, 1980;, pp 169-177.
28 +
Edelman DA, Berger GS, Keith L: Intrauterine Devices and Their Complications . Boston, Hall Medical Publishers, 1979;.
29 +
Ory HW, The Women's Health Study:  Ectopic pregnancy and intrauterine contraceptive devices: New perspectives. Obstet Gynecol 1981;;57:137-144.
30 +
Chow WH, Daling JR, Weiss NS, et al:  IUD use and subsequent tubal ectopic pregnancy. Am J Public Health 1986;;76:536-539.
31 +
DeStefano F, Peterson HB:  Ectopic pregnancy after sterilization. JAMA 1984;;251:1432.
32 +
McCausland AM:  High rate of ectopic pregnancy following laparoscopic tubal coagulation failures. Am J Obstet Gynecol 1980;;136:97-101.
33 +
DeStefano F, Peterson HB, Layde PM, et al:  Risk of ectopic pregnancy following tubal sterilization. Obstet Gynecol 1982;;60:326-330.
34 +
Chung CS, Smith RG, Steinhoff PG, et al:  Induced abortion and ectopic pregnancy in subsequent pregnancies. Am J Epidemiol 1982;;115:879-887.
35 +
Daling JR, Chow WH, Weiss NS, et al:  Ectopic pregnancy in relation to previous induced abortion. JAMA 1985;;253:1005-1008.
36 +
Panayotou PP, Kaskarelis DB, Miettinen OS, et al:  Induced abortion and ectopic pregnancy. Am J Obstet Gynecol 1972;;114:507-510.
37 +
Bender S:  The end-results in primary sterility. Br Med J 1952;;2:409-413.
38 +
Wyper JF B:  Pregnancy after primary infertility investigation. Br Med J 1962;;1:273-276.
39 +
Karow WG, Payne SA:  Pregnancy after clomiphene citrate treatment. Fertil Steril 1968;;19:351-362.
40 +
MacGregor AH, Johnson JE, Bunde CA:  Further clinical experience with clomiphene citrate. Fertil Steril 1968;;19:616-622.
41 +
Weiss DB, Aboulafia Y:  Ectopic gestation and hydatidiform mole in clomiphene-induced pregnancies. Lancet 1975;;2:1094-1095.
42 +
Marchbanks PA, Coulam CB, Annegers JF:  Clomiphene citrate and ectopic pregnancy. Fertil Steril 1986;;45:307-308.
43 +
Marchbanks PA, Coulam CB, Annegers JF:  An association between clomiphene citrate and ectopic pregnancy: A preliminary report. Fertil Steril 1985;;44:268-270.
44 +
Corson SL, Batzer FR:  Clomiphene citrate and ectopic pregnancy. Fertil Steril 1986;;45:307.
45 +
Weiss NS, Daling JR, Chow WH:  Control definition in case-control studies of ectopic pregnancy. Am J Public Health 1985;;75:67-68.
46 +
Hawkins DF, Elder MG: Human Fertility Control: Theory and Practice . Woburn, Mass, Butterworths, 1979;.
47 +
Chow WH, Daling JR, Weiss NS, et al:  Vaginal douching as a potential risk factor for tubal ectopic pregnancy. Am J Obstet Gynecol 1985;;153:727-729.

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