••• Chapter 29^ Ectopic Pregnancy^279
❍ What percentage of women with a previous ectopic pregnancy will conceive again?
About 60% of women with a history of an ectopic pregnancy will conceive again; 25% will be another ectopic
pregnancy. This may be dependent on age, history, prior infertility, and ectopic management.
❍ What is the best predictor of a successful intrauterine pregnancy in a woman with a history of ectopic
pregnancy?
The best predictor of another pregnancy is the condition of the contralateral tube.
❍ Is the rate of ectopic pregnancy higher or lower in women with an IUD?
The rate of any pregnancy is much lower with an IUD, including ectopic pregnancies. IUDs, however, are more
effective at preventing intrauterine pregnancy, making an ectopic pregnancy more likely if an IUD is in place. This
varies with a copper device having a rate of 5%, while a progesterone IUD increases the risk to about 23% due to
lowered tubal motility.
❍ Are ectopic pregnancies more or less likely during in vitro fertilization?
Ectopic pregnancies are more likely, accounting for 3% of in vitro fertilization pregnancies, especially with tubal
disease and very high hormone levels.
❍ Why do women who undergo clomiphene citrate or human menopausal gonadotropin ovulation induction
have a higher incidence of ectopic pregnancy?
Elevated levels of circulating estrogen or progesterone may alter the normal tubal contractility and delay transport
of the embryo.
❍ Does therapeutic abortion increase the risk of an ectopic pregnancy in the future?
When controlling for other variables, studies have found no association between elective abortion and subsequent
ectopic pregnancy.
❍ What is the most likely site of an ectopic pregnancy within the tube?
Over 80% of tubal pregnancies are ampullary; the next most common site is isthmic.
❍ Besides the tube, what is the most common location for an ectopic pregnancy?
Although 98% of ectopics are found in the tube, 1.4% are in the abdomen. Less common are ectopics in the
uterine cornua, cervix, and ovary.
❍ What is the incidence of ovarian pregnancy?
Ovarian pregnancy occurs in 1/7000 pregnancies, or 1 in 200 ectopic pregnancies.
❍ What are the risk factors for ovarian pregnancy?
It is a random event. History of PID or the use of an intrauterine contraceptive device does not increase the risk of
ovarian pregnancy.
❍ Does a history of ovarian pregnancy increase the risk of recurrent ectopic pregnancy or infertility?
There is no such association established.