Interpregnancy interval and risk of recurrence following tubal ectopic pregnancy: retrospective cohort study from UK tertiary center

Abstract

Objective: To assess the effect of interpregnancy interval on the odds of recurrence of tubal ectopic pregnancy (TEP) following expectant or surgical management. Methods: This was a retrospective cohort study conducted at a tertiary early pregnancy unit (EPU) in London, UK. Patients diagnosed with TEP following spontaneous conception, who had expectant or surgical management and who attended the EPU between December 2008 and January 2021 were included. Univariate and multivariate regression analyses were conducted to explore the association between the odds of recurrence of ectopic pregnancy and various factors, including maternal history, interpregnancy interval and management method of the index TEP, and analyses were adjusted for confounders. The main outcome measure was the odds of recurrence of extrauterine ectopic pregnancy in women presenting with a subsequent pregnancy. Results: A total of 1386 women with TEP were included, of whom 626 (45.2%) presented with a subsequent pregnancy. Fifty-nine of these women were excluded, as their subsequent pregnancy was conceived via in-vitro fertilization. From the remaining 567 women, 59 (10.4%) were diagnosed with recurrent extrauterine ectopic pregnancy. An interpregnancy interval of 6–18 months was associated with four times the odds of recurrence compared with an interval of ≤ 3 months (odds ratio (OR), 4.05 (95% CI, 1.37–12.03)). Women with two or more previous TEPs had more than three times the odds of recurrence compared to those with one previous TEP (OR, 3.27 (95% CI, 1.13–9.42)). Surgical management of the index TEP was associated with similar odds of recurrence as expectant management (OR, 1.26 (95% CI, 0.72–2.20)). Conclusions: Rapid conception after TEP is associated with low odds of recurrence. Therefore, purposeful delay to conception after TEP, including those managed expectantly, should not be recommended. Women with conception delay or a history of more than one ectopic pregnancy are at high risk of recurrent extrauterine ectopic pregnancy. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology