Chapter 1

and
pathogenesis Risk Factors of Ectopic
Pregnancy
iylah D. Reyes, MD, MSc

Background

Ectopic or extrauterine pregnancy is any pregnancy in which the fertilized ovum

implanted outside the uterine cavity.' 3 The number of ectopic pregnancies has
been noted to markedly increase in the past few decades. Based on hospital
discharge data, the incidence of ectopic pregnancy has risen from 4.5 cases per
1,000 pregnancies in 1970 to 19.7 cases per 1,000 pregnancies in 1992. 4 Likewise,
in the Philippines, the annual statistics on cases of ectopic pregnancy increased
from 13% in 2005 to 17% in 2009. 5 The incidence of ectopic pregnancy varies
among different countries. In Europe and the USA the incidence is estimated to be
at 1-2% of all pregnancies, )-3 while in the developing world, the incidence is much
higher at 1 in 10 women admitted with a diagnosis of tubal ectopic pregnancy.'''''
The incidence rate is reported to be as high as 1 in 28 in Jamaica and 1 in 40
pregnancies in Vietnam. Worldwide, it remains the most common cause of maternal
mortality in the first trimester of pregnancy accounting for 10-15% of all maternal
deaths. ~"° In the Philippines, mortality rate associated with ectopic pregnancy is
reported at 0.01-0.03%. "

The most common site of occurrence of extrauterine pregnancy is the fallopian

tube, occurring in 98% of cases.3'7"2 Ectopic pregnancy can also occur at the cornua
of the uterus, with 2.5% rate of occurrence. The uther uncommon sites are the
ovary, cervix or abdominal cavity.

There are several factors that increase the risk of ectopic pregnancy. The mechanism
-
common among these predisposing factors is the associated interference with
fallopian tube function. l'A This mechanism can be further categorized to anatomic,
When the scarred oviduct blocks the transport of the ovum, and functional, wherein
the extrauterine implantation resulted from impaired tubal mobility.' Currently,
he increased occurrence of certain risk factors is one of the attributes in the rising
ncidence of ectopic pregnancy, aside from the improved detection due to the

Vent d diagnostic modalities,'

c aPter, we will set the recommendations regarding the current risk

entified and correlate it with the pathogenesis of ectopic pregnancy. The

edge on the risk factors and its mechanism for ectopic pregnancy