Long-term reproductive outcomes in women whose first pregnancy is ectopic: a national controlled follow-up study.
OBJECTIVE
How does long-term reproductive prognosis among women whose first pregnancy is ectopic differ from prognosis in women with other initial pregnancy outcomes?


CONCLUSIONS
Women with a first recorded ectopic pregnancy (EP) have a significantly lower long-term delivery rate and a manifold increased risk of further EPs.


BACKGROUND
Women with a first EP have an increased risk of further EPs. Few studies have assessed long-term reproductive outcomes after an EP, and none was controlled.


METHODS
The study was designed as a historical controlled cohort study.


METHODS
Data were collected from four Danish registries covering the period 1977-2009. Women with an EP as their first recorded pregnancy during the period 1977-1982 were age matched with women whose first recorded pregnancy was a miscarriage, an induced abortion, a delivery, or women with no recorded pregnancies, respectively. The cohorts were followed until the end of 2009 or on average through 30 years.


RESULTS
When compared with women with a first miscarriage, women with a first EP had a relative risk of deliveries of 0.55 [95% confidence interval (CI) 0.52-0.58], miscarriages of 0.46 (0.41-0.52) and induced abortions of 0.72 (0.65-0.80) and a 4.7 (3.8-5.8)-fold increased risk of further EPs. The relative delivery rate when compared with women with a first induced abortion was 0.89 (0.84-0.95) and with women with no pregnancy 0.69 (0.65-0.72).


CONCLUSIONS
We had no information about the attempts to become pregnant in the different cohorts. New fertility techniques may have improved the prognosis among women with a first EP.


CONCLUSIONS
These results indicate that fertility is compromised in women whose first pregnancy is ectopic. It is possible that better assisted reproductive techniques that have been developed in recent years could improve the long-term delivery rates for women with EP.


BACKGROUND
All the expenses were covered by Gynaecological Clinic, Rigshospitalet. Ø.L. has within the last 3 years received honoraria for speeches in pharmacoepidemiological issues. L.L.K., P.E. and C.W.S. had no conflict of interest to declare.
Gynaecological Clinic 4232, Rigshospitalet, University of Copenhagen, Denmark. linelk@hotmail.com
Line
L
Lund Kårhus
Pia
P
Egerup
Charlotte
C
Wessel Skovlund
Øjvind
Ø
Lidegaard
D000028:Abortion, Induced / Q000009:adverse effects; D000022:Abortion, Spontaneous / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D017584:Reproductive History; D012306:Risk; D055815:Young Adult