Abstract
Objective This study aims to examine the risk for subsequent ectopic pregnancy in women with
prior cesarean delivery.
Study Design Women with a history of at least one cesarean delivery in the state of Utah during
1996 to 2011 were identified and compared with women with vaginal delivery only. The
primary outcome was subsequent ectopic pregnancy. Data were analyzed by multivariate
logistic regression and stratified by first, second, or third live births. Model covariates
included maternal age, ethnicity, marital status, education level, gravidity, and
prior ectopic pregnancy.
Results Overall, 260,249 women with at least one live birth were identified. After exclusions,
255,082, 154,930, and 70,228 women had at least one, two, and three prior live births
that lead to 531, 199, and 62 subsequent ectopic pregnancies, respectively. Women
who had one prior cesarean delivery were not at increased risk for subsequent ectopic
pregnancy in relation to women with no prior cesarean delivery. However, women with
two of two, two of three, or three of three prior cesareans had increased risk for
subsequent ectopic pregnancy with odds ratios (95% confidence interval) of 1.54 (1.06–2.22),
3.50 (1.49–8.24), and 1.99 (1.00–3.98), respectively.
Conclusion History of two or three cesarean deliveries is associated with increased risk for
subsequent ectopic pregnancy.
Keywords
cesarean delivery - ectopic pregnancy - long-term morbidity - risk factors
