-ECTOPIC PREGNANCY, INFERTILITY AND SUBSEQUENT EFFECTS ON FUTURE PREGNANCIES
Ectopic pregnancies do have a significant effect on the future chances of conception of many women and also on the route of delivery of some women later on when pregnant. Since most cases (over 95%) of ectopic pregnacices are tubal pregnancies, the implications of having a previous hsitory of one or more tubal pregnancies on infertility and the route of delivery of subsequent pregnancies will be given more attention in this article.
ECTOPIC PREGNANCY, INFERTILITY AND SUBSEQUENT EFFECTS ON FUTURE PREGNANCIES
1. After a previous history of an ectopic pregnancy, a woman has about 50-70% chance of having a normal or intra-uterine pregnancy. However, when compared to the normal population, there is a 3-5 times higher risk of having a recurrent tubal ectopic pregnancy. Given the serious health implications of tubal pregnancies including the risk of death, it is imperative that, after a missed period and a positive pregnancy test in any patient who has had a previous history of a tubal pregnancy, prompt presentation at the hospital for a detailed evaluation and an immediate assessment by the Gynecologists should be done to exclude a recurrent tubal pregnancy.
2. Secondly, since tubal pregnancies share similar causes and risk factors with tubal causes of infertility, there is also a significant chance of infertility due to tubal disease following a previous history of a tubal pregnancy. Let us just put it simply that since a woman normally has two fallopian tube, having a history of tubal pregnancy, already compromise one of the tubes and therefore reduces the chances of getting pregnant by half.
3. For those with two previous episodes of tubal pregnancies, there is a very high chance of tubal factor infertility secondary to bilateral tubal blockage with a near zero chance of getting pregnant through the normal route of conception i.e. via natural means of sexual intercourse. However, if one do get pregnant, there is a very high chance of the pregnancy being another tubal pregnancy. Hence, such women must urgently seek gynecological consultation to exclude or treat an ensuing ectopic pregnancy. But generally speaking, the most reliable option of conceiving by women with two or more previous history of a tubal pregnancy is by IVF and embryo transfer.
4. If a woman do have a normal or intra-uterine pregnancy after one or although unlikely, after two previous tubal ectopic pregnancies, such a woman can carry the pregnancy normally, go on into labor and deliver vaginally. This is especially true for all tubal pregnancies except some interstitial pregnancies.
5. Interstitial ectopic pregnancies are associated with a previous history of ipsilateral salpingectomy. Depending on the treatment modality, patients with interstitial pregnancies may not be allowed to go into labor in subsequent pregnancies. This is because, those surgically managed with cornua resection are at significant risk of uterine rupture due to the weakness of the upper part of the uterine wall which may give way and tear in labor. This if it occurs can result in massive bleeding into the abdomen during labour and if not adequately managed can lead to loss of life of the baby and or the mother. Such patients are usually offered elective caesarean section in subsequent pregnancies at term. Those who have successful medical treatment of their ectopic pregnancy do not require elective caesarean section provided there are no other indications for it.
6. Ovarian pregnancies and abdominal pregnancies are not likely to reoccur in subsequent pregnancies but cervical pregnancies and intramural pregnancies may reoccur. While theoretically a caesarean scar pregnancy may reoccur, evidence suggests that it hardly does. Cervical pregnancies and caesarean scar pregnancies are however associated with abnormal placenta implantation and a high chance of vaginal bleeding in subsequent pregnancies. Such pregnancies are often delivered by surgery and are at significant risk of hysterectomy.
1. Panelli D.M, Phillips C.H, Brady P.C. Incidence, diagnosis and management of tubal and non-tubal ectopic pregnancies: a review. Fertility Research and Practice2015 1:15. DOI: 10.1186/s40738-015-0008-z
2. Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 10. MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 21]. Ectopic Pregnancy; [updated 2010 Feb 21;] Available from http://www.nlm.nih.gov/medlineplus/ency/article/000895.htm