Recurrent tubal ectopic pregnancy management and the risk of a third ectopic pregnancy

Abstract Study Objective To evaluate the rate of a third ectopic pregnancy according to the modality of treatment of the second ectopic pregnancy. Design Retrospective cohort study Setting University affiliated tertiary medical center Patients One hundred and eleven women who had two ectopic pregnancies and a consecutive pregnancy between 2003 and 2018. Interventions Surgery or medical treatment as required Measurements and Main Results The modality of treatment of the second ectopic pregnancy was divided to three groups: expectant management, medical treatment with methotrexate and laparoscopic salpingectomy. Univariate and multivariate analyses were conducted to assess the association of various parameters of the second ectopic pregnancy and the occurrence of a third ectopic pregnancy in the consecutive pregnancy. Twenty women (18.0%) were managed expectantly, 55 (49.6%) were treated with methotrexate and 36 (32.4%) underwent surgery. Expectant management resulted in significantly higher rates of third ectopic pregnancy, as compared to treatment with methotrexate and surgical intervention (50.0% vs. 18.2% and 13.8%, respectively; p=0.005). In cases of two ipsilateral ectopic pregnancies, the interventional approach (medical or surgical treatment) resulted in lower recurrence rates, as compared to expectant management (25.7% vs 60.0%, respectively, p=0.043). Conclusion The risk of a third episode of an ectopic pregnancy after expectant management of a second ectopic pregnancy is extremely high. Interventional approach by methotrexate or salpingectomy is therefore preferred for recurrent ectopic pregnancy management, especially in ipsilateral recurrences.