Document Detail


Reproductive outcomes following ectopic pregnancy: register-based retrospective cohort study.
MedLine Citation:
PMID:  22723747     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We aimed to compare reproductive outcomes following ectopic pregnancy (EP) versus livebirth, miscarriage, or termination in a first pregnancy.
METHODS AND FINDINGS: A retrospective cohort study design was used. Scottish national data on all women whose first pregnancy occurred between 1981 and 2000 were linked to records of a subsequent pregnancy. The exposed cohort comprised women with an EP in their first pregnancy. There were three unexposed cohorts: women with livebirth, miscarriage, and termination of their first pregnancies. Any differences in rates of second pregnancy, livebirth, EP, miscarriage, or terminations and complications of a second ongoing pregnancy and delivery were assessed among the different exposure groups. A total of 2,969 women had an initial EP; 667,299 had a livebirth, 39,705 women miscarried, and 78,697 terminated their first pregnancies. Women with an initial EP had an increased chance of another pregnancy within 2 years (adjusted hazard ratio (AHR) 2.76 [95% CI 2.58-2.95]) or after 6 years (AHR 1.57 [95% CI 1.29-1.91]) compared to women with a livebirth. In comparison with women with an initial miscarriage, women who had an EP had a lower chance of a second pregnancy (AHR 0.53 [95% CI 0.50-0.56]). Compared to women with an initial termination, women with an EP had an increased chance of a second pregnancy (AHR 2.38 [95% CI 2.23-2.55]) within 2 years. Women with an initial EP suffered an increased risk of another EP compared to women with a livebirth (AHR 13.0 [95% CI 11.63-16.86]), miscarriage (AHR 6.07 [95% CI 4.83-7.62]), or termination (AHR 12.84 [95% CI 10.07-16.37]). Perinatal complications in a pregnancy following EP were not significantly higher than those in primigravidae or in women with a previous miscarriage or termination.
CONCLUSION: Women with an initial EP have a lower chance of conception than those who miscarry but an increased risk of a repeat EP in comparison with all three comparison groups. A major limitation of this study was the inability to separate women using contraception from those who were intending to conceive.
Authors:
Sohinee Bhattacharya; David J McLernon; Amanda J Lee; Siladitya Bhattacharya
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-06-19
Journal Detail:
Title:  PLoS medicine     Volume:  9     ISSN:  1549-1676     ISO Abbreviation:  PLoS Med.     Publication Date:  2012  
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-11-19     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  101231360     Medline TA:  PLoS Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1001243     Citation Subset:  IM    
Affiliation:
Obstetric Epidemiology, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland. sohinee.bhattacharya@abdn.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Abortion, Induced / statistics & numerical data
Abortion, Spontaneous / epidemiology
Adult
Female
Humans
Kaplan-Meier Estimate
Odds Ratio
Pregnancy
Pregnancy Complications
Pregnancy Outcome / epidemiology*
Pregnancy, Ectopic / epidemiology*
Proportional Hazards Models
Registries / statistics & numerical data*
Reproduction*
Retrospective Studies
Scotland / epidemiology
Stillbirth / epidemiology
Young Adult
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