Abstract


OBJECTIVE: Well-known risk factors for ectopic pregnancy (EP) are maternal-related ones, including previous EP, prior pelvic surgery or pelvic inflammation, chlamydial infection, ART pregnancies, and so on. However, few studies have focused on weather embryo-associated factors exist. The purpose of this study is to compare the frequencies of chromosomal abnormality of EP conceptus with those of intrauterine pregnancies, to identify variables that might affect the incidence of EP, and to assess their roles on the etiology of EP. view more

OBJECTIVE: Well-known risk factors for ectopic pregnancy (EP) are maternal-related ones, including previous EP, prior pelvic surgery or pelvic inflammation, chlamydial infection, ART pregnancies, and so on. However, few studies have focused on weather embryo-associated factors exist. The purpose of this study is to compare the frequencies of chromosomal abnormality of EP conceptus with those of intrauterine pregnancies, to identify variables that might affect the incidence of EP, and to assess their roles on the etiology of EP.
DESIGN: Retrospective case control study
MATERIALS AND METHODS: We have had 88 operation-treated EP for 8 years since 2007. All chorionic villous samples obtained during surgical treatment could be successfully analyzed for cytogenetic study using direct and culture method (Group A). As controls, we chose consecutive 753 singleton intrauterine pregnancies in the first half of 2014, including 103 miscarriages (Group B). In the cases of miscarriage, intrauterine fetal death, and fetal/neonatal anomaly were all examined by karyotype analysis of chorionic villi or placenta. Our laboratory did not apply PGD/PGS to ART cases. Intrauterine pregnancies delivering a healthy neonate with normal appearance were assumed to be normal karyotyped subjects. Demographic information defining our study population were all collected from medical records, including maternal age, parity, risk factors for EP, method of conception, and neonatal sex. The odds ratios of variables of interest (with 95% confidence interval) for EP were calculated using multivariate logistic regression.
RESULTS: The results of our study are shown in the table below. In Group A, only 3 cases (3.4%: 3/88) showed abnormal chromosomal composition. On the other hand, 76 cases in Group B were identified as having chromosomal abnormalities (10.1%: 76/753). The rate of abnormal karyotype in Group A was statistically lower than in Group B (P<0.05). One or more risk factors for EP were identified in 48 cases of Group A (54.5%: 48/88), and 117 cases of Group B (15.5%, 117/ 753), also indicating a statistically significant difference (P<0.001).

Baseline characteristics and adjusted odds ratio (aOR) for ectopic pregnancy(EP)
Group A (EP: n=88) Group B (Intrauterine Pregnancy: n=753), including 103 miscarriages aOR for EP (95% CI, P value)
Maternal age (y.o.) 31.8±4.3 31.7±4.4 1.01 (0.95 - 1.08. 0.67)
Parity (multipara / primipara) 18 / 70 347 / 406 0.27 (0.15 - 0.48, <0.001*) / 1.00 (reference)
Chromosomal abnormality (yes / no) 3 / 85 76 / 677 0.18 (0.04 - 0.55, <0.01*) / 1.00
Risk factors for EP (yes / no) 48 / 40 117 / 636 6.93 (4.27 - 11.36, <0.001*) / 1.00
ART pregnancy (yes / no) 14 / 74 61 / 692 1.46 (0.67 - 3.04, 0.32) / 1.00
Sex chromosome (male / female) 46 / 42 368 / 385 1.08 (0.67 - 1.75, 0.76) / 1.00

[Note of the table: Data are mean±SD or number of subjects. Odds ratios were all adjusted for maternal age and parity. *P<0.05 was considered statistically significant.]
CONCLUSIONS: 1) Embryos with abnormal karyotype and multipara might possess some defensive mechanisms against EP. 2) Maternal age, ART pregnancy, and sex of conceptus did not affect the occurrence of EP. 3) Widely known risk factors for EP were confirmed to be a more plausible explanation for the etiology of EP than embryo-associated factors.

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