Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
Fertil Steril. 2019 Jul;112(1):112-119. doi: 10.1016/j.fertnstert.2019.03.019. Epub 2019 May 2.
To provide information on the birth outcomes of future intrauterine pregnancies in women whose first pregnancy was ectopic.
Population-based longitudinal cohort study.
All hospitals in Quebec, Canada, 1989-2013.
PATIENT(S): Group surgically treated for an ectopic first pregnancy: 15,823 women; comparison group with an intrauterine first pregnancy: 1,101,748 women.
INTERVENTION(S): Not applicable.
MAIN OUTCOME MEASURE(S): Repeat ectopic pregnancy, future delivery of a live infant, stillbirth, cesarean delivery, preterm birth, low birth weight, preeclampsia, gestational diabetes, and postpartum hemorrhage as well as other outcomes of pregnancy.
RESULT(S): The overall prevalence of ectopic first pregnancy was 14.2 per 1,000 women, of whom 10% of women with an ectopic first pregnancy had a future ectopic. Regardless of age, women with ectopic first pregnancies had an increased risk of adverse birth outcomes at future intrauterine pregnancies, including 1.27 times the risk of preterm birth (95% confidence interval [CI], 1.18-1.37), 1.20 times the risk of low birth weight (95% CI, 1.10-1.31), 1.21 times the risk of placental abruption (95% CI, 1.04-1.41), and 1.45 times the risk of placenta previa (95% CI, 1.10-1.91). Older women with a prior ectopic pregnancy had particularly elevated risks of placental abruption (risk ratio 1.42; 95% CI, 1.16-1.69).
CONCLUSION(S): Women with ectopic first pregnancies have an increased risk of adverse birth outcomes during subsequent intrauterine pregnancies. These women may benefit from closer clinical management in pregnancy to prevent adverse birth outcomes.
为首次异位妊娠的女性提供其未来宫内妊娠结局的信息。
基于人群的纵向队列研究。
加拿大魁北克省所有医院，1989 年至 2013 年。
接受手术治疗的首次异位妊娠组：15823 名女性；首次宫内妊娠的对照组：1101748 名女性。
无。
再次异位妊娠、未来活婴分娩、死产、剖宫产、早产、低出生体重、子痫前期、妊娠期糖尿病和产后出血以及妊娠的其他结局。
首次异位妊娠的总体患病率为 14.2/1000 名女性，其中 10%的首次异位妊娠女性有未来异位妊娠。无论年龄大小，首次异位妊娠的女性在未来宫内妊娠时发生不良妊娠结局的风险增加，包括早产风险增加 1.27 倍（95%置信区间[CI]，1.18-1.37）、低出生体重风险增加 1.20 倍（95% CI，1.10-1.31）、胎盘早剥风险增加 1.21 倍（95% CI，1.04-1.41）和前置胎盘风险增加 1.45 倍（95% CI，1.10-1.91）。有过异位妊娠的老年女性发生胎盘早剥的风险特别高（风险比 1.42；95% CI，1.16-1.69）。
首次异位妊娠的女性在随后的宫内妊娠中发生不良妊娠结局的风险增加。这些女性可能受益于更密切的妊娠临床管理，以预防不良妊娠结局。
