**4.6 Increasing age**

238 Ectopic Pregnancy – Modern Diagnosis and Management

Cornual ectopics share the common risk factors of other ectopic pregnancies which are:

salpingitis increases the risk of ectopic pregnancy by 4 fold. (Westrom L et al, 1981)

**4.3 History of tubal surgery and conception after tubal ligation** 

The incidence of tubal damage after the first episode of PID is 13%. This incidence increases to 35% after the second episode of PID and to 75% after the third episode. A history of

After one ectopic pregnancy, patients have a 7-13 fold increase in the likelihood of another ectopic pregnancy. Method of management of previous ectopic pregnancy influences the chance of recurrence. The incidence is increased according to the size of the ectopic pregnancy specially if treated salpingostomy. The incidence of recurrence of ectopic is 18% and 8% after treatment with sapingotomy and salpingectomy respectively though the chance of future intrauterine pregnancy is 89% after salpingostomy compared with 66%

Salpingectomy, salpingostomy, neosalpingostomy, fimbrioplasty, tubal reanastomosis, and lysis of peritubal or periovarian adhesions are associated with an increased risk of ectopic

Fig. 1. Sites and frequencies of ectopic pregnancy.

**4.1 Pelvic inflammatory disease (PID)** 

**4.2 History of previous ectopic pregnancy** 

after salpingectomy. (Silva Pet al, 1993)

**4. Risk factors** 

pregnancies.

Women over 40 years of age have a 3 – 4 fold increase in the risk for developing an ectopic pregnancy compared to women aged 15-24 years. This has been attributed to a possible progressive loss of myoelectrical activity along the fallopian tube with ageing or to the deterioration in the quality of the fertilised egg.

### **4.7 Smoking**

Smoking has been shown to increase the risk of ectopic pregnancy by 3 fold. To date, no study has supported a specific mechanism by which cigarette smoking affects the incidence of ectopic pregnancy however, delayed ovulation, altered tubal motility, or altered immunity have been suggested. (Coste J et al, 1991)

#### **4.8 Previous pelvic surgeries**

Previous pelvic surgeries have shown to increase the risk of ectopic pregnancy. Right ectopic pregnancy seems to be more frequent than left due to history of appendicitis or even subclinical subacute inflammation of the appendix.

#### **4.9 Other**

Salpingitis isthmica nodosum like any other inflammation of the tubes has been thought to be associated with increase incidence of ectopic pregnancy.
