Ectopic pregnancy after hysterectomy: a review and insight into etiology and prevention

Objective: To review all reported cases of ectopic pregnancy after hysterectomy. Design: Medline literature search 1966 to Jan 2009. Search terms included "ectopic pregnancy," "post hysterectomy ectopic pregnancy," "pregnancy after hysterectomy." The bibliography of all retrieved articles was searched for additional sources of data. Setting: Academic medical center. Patient(s): Women with ectopic pregnancies following hysterectomy. Intervention(s): Surgical removal. Main Outcome Measure(s): To review all reported cases of ectopic pregnancy after hysterectomy. Result(s): Fifty-six cases of ectopic pregnancies after hysterectomy have been reported. Thirty-one such cases were diagnosed and treated in the immediate period after hysterectomy, "early presentation," and were pregnancies presumed to have been present at the time the hysterectomy was performed. Twenty-five cases of "late presentation" ectopic pregnancy after hysterectomy have been reported, certainly developing as a result of a communication between the vagina and the peritoneal cavity. Conclusion(s): Every woman with intact ovaries, despite previous hysterectomy, who presents with abdominal pain, should be screened for pregnancy. "Early presentation" ectopic pregnancies can be prevented with adequate contraception before hysterectomy or by avoiding operating in the periovulatory or luteal phase of the menstrual cycle. "Late presentation" ectopic pregnancies after hysterectomy are likely dependent on the type of hysterectomy performed and the presence or a residual cervix. (Fertil Steril(R) 2010;94:431-5. (C) 2010 by American Society for Reproductive Medicine.)