Risk factors for ectopic pregnancy: a multi-center case-control study.
Risk factors for ectopic pregnancy: a multi-center case-control study.
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DOI：
10.1186/s12884-015-0613-1
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发表时间：
2015-08-22
影响因子：
3.1
通讯作者：
Zhang J
中科院分区：
文献类型：
--
作者：
Li C;Zhao WH;Zhu Q;Cao SJ;Ping H;Xi X;Qin GJ;Yan MX;Zhang D;Qiu J;Zhang J
宫外孕（EP）是妊娠早期孕产妇死亡的主要原因。更好地了解EP风险有助于预防其发生。本研究采用多中心、大样本、病例对照研究的方法，对上海地区EP的危险因素进行了评价。从中国上海的五家医院招募了诊断为EP的妇女（n = 2411）和宫内妊娠妇女（n = 2416）。从所有参与者中收集有关社会人口学特征、生殖、妇科和手术史以及既往和当前使用避孕药的信息。计算比值比（OR）和95%置信区间（CI），并通过多变量logistic回归分析调整潜在混杂因素。研究表明，EP的风险与包括既往EP在内的传统危险因素有关（校正比值比[AOR] = 2.72，95% CI：1.83-4.05），既往沙眼衣原体感染（校正OR = 3.18，95% CI：2.64，3.84），既往不孕（AOR = 2.18，95% CI：1.66-2.88），既往附件手术（AOR = 2.09，95% CI：1.49-2.93）、既往阑尾切除术（AOR = 1.64，95% CI：1.13-2.37）和既往使用宫内节育器（IUD）（AOR = 1.72，95% CI：1.39-2.13）。此外，在当前周期中使用的大多数避孕药（包括宫内节育器）失败后，EP风险增加（AOR = 16.43，95%CI：10.42-25.89），口服避孕药（AOR = 3.02，95%CI：1.16-7.86）、左炔诺孕酮紧急避孕（AOR = 4.75，95%CI：3.79-5.96）和女性绝育（AOR = 4.73，95%CI：1.04-21.52）。分层分析显示，体外受精和胚胎移植（IVF-ET）是输卵管性不孕妇女发生EP的主要危险因素（AOR = 8.99，95% CI：1.98-40.84），尽管IVF-ET与非输卵管性不孕妇女的EP无关（AOR = 2.52，95% CI：0.14-44.67）。除了传统的危险因素外，IVF-ET和目前使用的IUD在EP的发生中起主导作用。应注意接受过IVE-ET治疗的输卵管性不孕症妇女。
Ectopic pregnancy (EP) is the leading cause of maternal death during the first trimester of pregnancy. A better understanding of EP risk can help prevent its occurrence. We carried out a multi-center, large-sample, case-control study to evaluate the risk factors for EP in Shanghai, China. Women who were diagnosed with EP (n = 2411) and women with intrauterine pregnancies (n = 2416) were recruited from five hospitals in Shanghai, China. Information regarding the sociodemographic characteristics; reproductive, gynecological and surgical history; and previous and current use of contraceptives was collected from all participants. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated and adjusted for potential confounding factors via multivariate logistic regression analysis. The study revealed that the risk of EP was associated with the traditional risk factors including previous EP (Adjusted odds ratio [AOR] = 2.72, 95 % CI: 1.83–4.05), previous Chlamydia trachomatis infection (Adjusted OR = 3.18, 95 % CI: 2.64, 3.84), previous infertility (AOR = 2.18, 95 % CI: 1.66–2.88), previous adnexal surgery (AOR = 2.09, 95 % CI: 1.49–2.93), previous appendectomy (AOR = 1.64, 95 % CI: 1.13–2.37), and previous use of intrauterine devices (IUDs) (AOR = 1.72, 95 % CI: 1.39–2.13). Additionally, EP risk was increased following the failure of most contraceptives used in the current cycle including IUDs (AOR = 16.43, 95 % CI: 10.42–25.89), oral contraceptive pills (AOR = 3.02, 95 % CI: 1.16–7.86), levonorgestrel emergency contraception (AOR = 4.75, 95 % CI: 3.79–5.96), and female sterilization (AOR = 4 .73, 95 % CI: 1.04–21.52). Stratified analysis showed that in vitro fertilization and embryo transfer (IVF-ET) was the main risk factor for EP in women with tubal infertility (AOR = 8.99, 95 % CI: 1.98–40.84), although IVF-ET showed no association with EP in women with non-tubal infertility (AOR = 2.52, 95 % CI: 0.14–44.67). In addition to the traditional risk factors, IVF-ET and current IUD use play dominant roles in the occurrence of EP. Attention should be given to women with tubal infertility who have undergone IVE-ET treatment.