ECTOPIC PREGNANCY IN STERILIZED AND NONSTERILIZED WOMEN - A COMPARISON

OBJECTIVE: To assess whether differences occurred in the presentation, treatment and postoperative outcomes of ectopic pregnancy in steriliz ed and nonsterilized women. STUDY DESIGN: All cases of ectopic pregnan cy admitted over five years at two hospitals were reviewed. Using a ca se-control method, patients with ectopic pregnancy and prior tubal ste rilization were compared with the next nonsterilized patient with ecto pic pregnancy admitted within 30 days. Statistical comparison, utilizi ng t tests, chi(2) tests or Fisher's exact test, when appropriate, was performed. RESULTS: Thirty-eight (18%) of 208 patients with ectopics during the study period had undergone prior sterilization. This group, when compared with the 38 nonsterilized patients with ectopics, was s imilar for gestational age at diagnosis, frequency of pelvic inflammat ory and sexually transmitted diseases, and mean human chorionic gonado tropin (hCG) level; the preoperative sonographic findings were also si milar in the two groups. Sterilized patients were less likely than con trols to have had serial hCG levels, while their mean duration of symp toms at admission was shorter. Although both groups had a similar dist ribution of surgical management (laparoscopy, laparotomy or both) and postoperative complications, there were trends toward a higher risk of ectopic rupture and hemoperitoneum in sterilized patients. CONCLUSION : Ectopic pregnancies following tubal sterilization have clinical mani festations and surgical outcomes similar to those occurring without pr ior sterilization, except for less frequent determination of serial hC Gs, probably related to a shorter duration of reported preceding sympt oms. The trend toward more frequent rupture and hemoperitoneum in this , group suggests that sterilized patients are less likely to heed the early warnings of this complication.