What is recurrent ectopic pregnancy, what are the causes of its recurrence, and how can it be prevented?

An ectopic pregnancy is a condition in which a fertilized egg implants and grows outside the main cavity of the uterus; this occurs in the fallopian tube in more than 90% of cases. When an ectopic pregnancy is recurrent, it means that a woman has experienced this condition more than once. An ectopic pregnancy is a serious condition because it cannot progress normally, and as the pregnancy grows, it can cause the fallopian tube to rupture, leading to severe internal bleeding that is life-threatening and requires immediate surgical intervention [1].

Causes of Recurrent Ectopic Pregnancy

There are several factors that increase the risk of ectopic pregnancy recurrence, most notably:

• Previous history of ectopic pregnancy: A prior ectopic pregnancy is one of the most significant risk factors for recurrence [1].
• Prior surgery on the fallopian tubes, pelvis, or abdomen: Any previous surgical intervention in these areas can affect the integrity and function of the fallopian tubes [1].
• Sexually transmitted infections (STIs): Some of these infections can cause damage to the fallopian tubes [1].
• Pelvic Inflammatory Disease (PID): This is an infection that affects the uterus, fallopian tubes, and adjacent pelvic structures, potentially leading to scarring that obstructs the passage of the egg [1].
• Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, which can affect the fallopian tubes [1].
• Exposure to diethylstilbestrol (DES) in utero: Women who were exposed to this substance as fetuses have an increased risk of ectopic pregnancy [2].
• Other factors: Such as smoking, age over 35, history of infertility, and the use of assisted reproductive technologies like in vitro fertilization (IVF) [1].

How to Prevent Recurrent Ectopic Pregnancy

Although it is not always possible to completely prevent the recurrence of an ectopic pregnancy, there are steps that can be taken to reduce the risks and increase the chances of a healthy pregnancy in the future:

• Early care and close monitoring in subsequent pregnancies: If you have a history of ectopic pregnancy, it is essential to inform your doctor immediately if you suspect you are pregnant. Your doctor will monitor the pregnancy closely to ensure it is developing in the correct location within the uterus [1].
• Early diagnosis: This includes performing ultrasound scans and blood tests to measure human chorionic gonadotropin (hCG) levels to determine the location of the pregnancy as early as possible [1].
• Treating risk factors: Treating STIs or pelvic inflammatory disease can reduce damage to the fallopian tubes.
• Quitting smoking: Smoking is a well-known risk factor for ectopic pregnancy [1].
• Genetic counseling: In some cases, genetic counseling may be necessary if there is a family history or specific risk factors.

Diagnosing Ectopic Pregnancy in Subsequent Pregnancies

When a woman has had a previous ectopic pregnancy, early diagnosis of the next pregnancy is crucial. The doctor will perform a pelvic examination and an ultrasound to observe where the pregnancy is developing. Blood tests for human chorionic gonadotropin (hCG) levels will also be conducted [1]. In the event of symptoms such as abnormal vaginal bleeding or pelvic pain, you should report them to your doctor immediately [1].

Treatment Options for Ectopic Pregnancy

An ectopic pregnancy cannot be moved to the uterus; therefore, it always requires treatment [1]. Treatment options include:

• Medication: Methotrexate is the most common medication used; it works by stopping cell growth and ending the pregnancy, which the body then absorbs over 4-6 weeks. This medication is used if the fallopian tube has not ruptured and requires careful monitoring of hCG levels [1].
• Surgery: If the fallopian tube has ruptured, emergency surgery is necessary [1]. The pregnancy may be removed from the fallopian tube, or the entire tube may be removed along with the pregnancy; this is usually performed via laparoscopy [1].

After treatment, a woman may feel tired for several weeks, and it may take some time for hCG levels to return to normal and for menstrual cycles to resume their normal pattern [1]. It is very important to seek emotional and psychological support after the experience of an ectopic pregnancy, as it can be a traumatic experience [1]. Further information on this topic can be found via the following link: Recurrent ectopic pregnancy: causes and prevention (Arabic).

When to Seek Emergency Care

You must go to the emergency department immediately if serious symptoms appear that may indicate a ruptured fallopian tube, such as sudden and severe abdominal or pelvic pain, shoulder pain, weakness, dizziness, or fainting [1].

Medical references

• Ectopic Pregnancy
• Diethylstilbestrol (DES) Exposure and Cancer