Risk factors and clinical features of recurrent ectopic pregnancy: a case control study

Objective: To compare signs and symptoms between patients with recurrent and single ectopic pregnancies. Design: Case-control study. Setting: University medical center. Patient(s): Three hundred six women with single ectopic pregnancies and 61 women with recurrent ectopic pregnancies. Intervention(s): None. Main Outcome Measure(s): Risk factors, historical factors, and findings at presentation that may predispose to recurrent ectopic pregnancy. Result(s): The risk of recurrent ectopic pregnancy was increased with a history of surgery, history of live birth, and history of spontaneous miscarriage and not with a history of gonorrhea, chlamydia, pelvic inflammatory disease, Caesarean section, or pregnancy termination. Patients with a recurrent ectopic pregnancy had a nonsignificant trend toward higher initial hCG values. The majority of ultrasounds in both groups were nondiagnostic on presentation. The patients with recurrent ectopic pregnancy were less likely to have bleeding on initial presentation, though both groups had similar complaints of pain. Conclusion(s): Secondary prevention of ectopic pregnancy is problematic because of the paucity of risk factors that can be modified to diminish the odds of recurrence. Clinicians' ability to both diagnose and counsel patients at risk for recurrent ectopic pregnancy can be optimized by awareness of the clinical features of this condition. (C) 2003 by American Society for Reproductive Medicine.