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  • Title: Multiple induced abortions as risk factor for ectopic pregnancy. A prospective study.
    Author: Skjeldestad FE, Gargiullo PM, Kendrick JS.
    Journal: Acta Obstet Gynecol Scand; 1997 Aug; 76(7):691-6. PubMed ID: 9292646.
    Abstract:
    OBJECTIVE: To assess the risk of ectopic pregnancy by the number of previous induced abortions. DESIGN: Prospective cohort study. METHODS: Three thousand seven hundred and fifty-four women, 39 years old or younger, living permanently in one Norwegian county, who had had at least one induced abortion between January 1, 1987 and December 31, 1992, at the University Hospital of Trondheim, Norway were followed prospectively for histologically verified ectopic pregnancies until December 31, 1993. Exposure time was measured from the most recent induced abortion (index abortion) until the ectopic pregnancy, closure date, or the subject's 40th birthday. Statistical analyses were done in SAS applying survival analyses and poisson regression. RESULTS: During the follow-up period of 164,167 women-months, we observed 24 ectopic pregnancies in 3,754 women. The adjusted incidence density ratio (aIDR) for women who had had two or more induced abortions was 1.2 (95% CI: 0.5-3.1) in comparison with the reference group of women who had had one induced abortion. Measuring exposure as increasing number of consecutive induced abortions, no dose-response to ectopic pregnancy was found between two consecutive (aIDR 0.9) and three or more consecutive abortions (aIDR 1.1) in comparison with the reference group. CONCLUSION: In our setting, no excess risk of ectopic pregnancy was associated with multiple previous induced abortions compared with one previous induced abortion. To assess the association between induced abortion and subsequent ectopic pregnancy, 3754 Norwegian women 39 years or younger who had at least one induced abortion at the University Hospital of Trondheim during 1987-92 were followed for histologically confirmed ectopic pregnancies through the end of 1993. In a total of 164,167 woman-months of follow-up, 24 ectopic pregnancies were recorded. No woman had more than one ectopic pregnancy. The overall cumulative incidence of ectopic pregnancy among women with an induced abortion history rose from 3.5 per 1000 women at 1 year to 11.1 per 1000 women at 6 years of follow-up. The adjusted incidence density ratio (aIDR) for women with 2 or more induced abortions was 1.2 (95% confidence interval, 0.5-3.1). No dose-response to ectopic pregnancy was found between 2 consecutive (aIDR, 0.9) and 3 or more consecutive (aIDR, 1.1) abortions compared with the reference group. Ectopic pregnancy after the most recent abortion was more likely to occur among women whose first pregnancy ended as an ectopic one than among those whose first pregnancy resulted in a birth. Although the results of longer-term follow-up of this cohort of Norwegian women have not yet been analyzed, the present findings suggest that induced abortion does not increase the risk of ectopic pregnancy.
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