RISK-FACTORS FOR ECTOPIC PREGNANCY - A METAANALYSIS

Objective: To review current knowledge on the risk of ectopic pregnanc y (EP), with the exception of contraceptive methods. Design: Meta-anal ysis. Setting: Case control and cohort studies published between 1978 and 1994 in English, French, German, or Dutch, retrieved by Medline se arch, crossover search from the papers obtained, and hand-search on re cent medical journals. Patients: A total number of 6,718 cases of EP i n 27 case control studies and 13,049 exposed women in 9 cohort studies . Main Outcome Measures: Detected studies were tested for homogeneity. if homogeneity was not rejected, Mantel-Haenszel common odds ratios ( OR) and 95% confidence intervals were calculated. Results: Previous EP , previous tubal surgery, documented tubal pathology, and in utero die thylstilbestrol (DES) exposure were found to be associated strongly wi th the occurrence of EP. Previous genital infections (pelvic inflammat ory disease [PID], chlamydia, gonorrhoea), infertility, and a Lifetime number of sexual partners >1 were associated with a mildly increased risk. For gonorrhoea, PID, previous EP, previous tubal surgery, and sm oking, a higher common OR was calculated when using pregnant controls compared with using nonpregnant controls. Conclusions: The strong risk in women with a previous EP, previous tubal surgery, documented tubal pathology, or in utero DES exposure justifies the exploration of a sc reening policy for EP among these women. if a risk, factor reduces fer tility chances, the OR detected when using pregnant controls is higher than the OR calculated using nonpregnant controls.