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  • Title: The etiology of ectopic pregnancy.
    Author: Russell JB.
    Journal: Clin Obstet Gynecol; 1987 Mar; 30(1):181-90. PubMed ID: 2953513.
    Abstract:
    The cause of ectopic pregnancy is associated with two major categories: the integrity of the oviduct and the quality of the fertilized ovum. Several conditions that alter the tubal transport system include inflammatory insults, intrauterine devices, surgical manipulation, tubal ligations, salpingitis isthmica nodusa, DES exposure, and induced abortions. Risk factors that may theoretically alter ovum quality or the hormonal environment include ovulation induction, fertilization in vitro, delayed ovulation, and transperitoneal ovum migration. As we continue to investigate the fallopian tube and the fertilized ovum as unique entities, our knowledge will increase about the cause of ectopic gestations. The causes of ectopic pregnancy, divided into those arising from abnormal ovum transport and those due to abnormalities of the egg itself, are presented. The fallopian tube is not a passive conduit, but the active site of sperm capacitation, egg capture and fertilization. Conditions resulting in damage to tubal lining such as salpingitis, even if it is subclinical as often occurs with Chlamydia, increase risk of tubal pregnancy. Other causes of damage to tubes include vaginal douching, especially with commercial products, laparoscopic tubal ligation if it creates fistulas, even microsurgical reconstruction and conservative surgery for prior ectopic pregnancy. For unknown reasons, IUD use, the thickening of the tube seen in salpingitis isthmic nodosa, and exposure to diethylstilbestrol are also risk factors. Unresolved is the controversy over whether previous induced abortions predispose one ectopic pregnancy; possibly 2 or more abortions, or illegal abortions may adversely affect the statistics. Factors detrimental to ovum quality that lead to ectopic pregnancy include induced ovulation, in vitro fertilization, delayed ovulation and migration of the ovum to the contralateral tube.
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