**4.1 Pelvic inflammatory disease (PID)**

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

### **4.2 History of previous ectopic pregnancy**

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% after salpingectomy. (Silva Pet al, 1993)

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

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

One third of patients who conceive after a tubal ligation are reported to experience an ectopic pregnancy. Ectopic pregnancies following tubal ligation usually occur 2 or more years after sterilization, rather than immediately after. In the first year, only about 6% of sterilization failures result in ectopic pregnancy. (DeStefano F, 1982)
