title: Long-term risk of ectopic pregnancy varies by method of tubal sterilization: a whole-population study.
abstract: OBJECTIVE
  To evaluate the risk of ectopic pregnancy (EP) associated with different methods of tubal sterilization.
  
  
  METHODS
  Population-based retrospective cohort study.
  
  
  METHODS
  Hospitals in Western Australia.
  
  
  METHODS
  All women aged 18-44 years undergoing tubal sterilization between 1990 and 2010 at Western Australian hospitals (n = 44,829).
  
  
  METHODS
  Data on tubal sterilization were extracted from hospital records.
  
  
  METHODS
  Long-term risk of EP.
  
  
  RESULTS
  There were 89 EPs recorded during the observation period in women previously sterilized. The 10-year and 15-year cumulative probability of EP for all methods of tubal sterilization were 2.4/1,000 and 2.9/1,000 procedures, respectively. The 10-year cumulative probability of EP was 3.5 times higher in women sterilized before the age of 28 years than in those sterilized after the age of 33 years. An increased risk of EP existed in women who received laparoscopic partial salpingectomy (adjusted hazard ratio = 14.57, 95% confidence interval 3.50-60.60) and electrodestruction (adjusted hazard ratio = 5.65, 95% confidence interval 2.38-13.40), compared with those who had laparoscopic unspecified destruction of fallopian tubes.
  
  
  CONCLUSIONS
  Women undergoing tubal sterilization at a young age are at particular risk for subsequent EP. The risk among younger women doubled between 5 and 15 years after sterilization. Laparoscopic electrodestruction and partial salpingectomy carried the highest risk of EP.
authors.affiliation: Centre for Health Services Research, School of Population Health, Crawley, Western Australia, Australia. Electronic address: eva.malacova@uwa.edu.au.
authors.forename: Eva
authors.initials: E
authors.lastname: Malacova
authors.affiliation: Centre for Health Services Research, School of Population Health, Crawley, Western Australia, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Kemp
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Crawley, Western Australia, Australia; Fertility Specialists of Western Australia, Claremont, Western Australia, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Hart
authors.affiliation: Centre for Health Services Research, School of Population Health, Crawley, Western Australia, Australia.
authors.forename: Khadra
authors.initials: K
authors.lastname: Jama-Alol
authors.affiliation: Centre for Health Services Research, School of Population Health, Crawley, Western Australia, Australia.
authors.forename: David Brian
authors.initials: DB
authors.lastname: Preen
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013246:Sterilization, Tubal / Q000009:adverse effects* / Q000639:trends*; D013997:Time Factors; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: Cohort studies; age; ectopic pregnancy; life tables; tubal sterilization