Endometriosis and Ectopic Pregnancy: A Meta-analysis |
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| Affiliation: | 1. Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia (Drs. Montgomery and Mortlock);2. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California (Dr. Giudice);1. Department of Obstetrics and Gynecology, Monash University, Clayton (Prof. Rombauts and Dr. Fernando), Australia;2. Women''s Health, Monash Health, Clayton (Prof. Rombauts and Dr. Fernando), Australia;3. Monash IVF Group, Richmond (Prof Rombauts), Australia;4. Department of Obstetrics, Gynecology and Fertility, Lis Maternity Hospital (Drs. Lantsberg and Cohen);5. Sourasky Tel-Aviv Medical Center (Drs. Lantsberg and Cohen), and Sackler Faculty of Medicine (Drs. Lantsberg and Cohen), Tel-Aviv University, Israel;1. Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona (Drs. Ceccaroni, Manzone, Stepniewska, and Clarizia);2. Department of Medicine and Aging Sciences, “Gabriele d''Annunzio” University of Chieti–Pescara, Chieti (Dr. Finelli), Italy. |
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| Abstract: | ObjectiveTo systematically review and perform a meta-analysis of the risk of ectopic pregnancy in endometriosis.Data SourcesMEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), and Cochrane Library to April 1, 2019. Inclusion criteria were cohort or case-control studies from 1990 onward. Exclusion criteria were cohort studies without controls, case reports or series, or no English full-text.Methods of Study SelectionA total of 1361 titles/abstracts were screened after removal of duplicates, 39 full-texts were requested, and, after 24 studies were excluded, there were 15 studies in the meta-analysis.Tabulation, Integration, and ResultsData were extracted using standardized spreadsheets with 2 independent reviewers, and conflicts were resolved by a third reviewer. We performed random effects calculation of weighted estimated average odds ratio (OR). Heterogeneity and publication bias were assessed with the I2 metric and funnel plots/Egger's test, respectively. The Ottawa-Newcastle Quality Assessment Scale was used with a cutoff of ≥7 for higher quality. There were 10 case-control studies (17 972 ectopic pregnancy cases and 485 266 nonectopic pregnancy controls) and 5 cohort studies (30 609 women with endometriosis and 107 321 women without endometriosis). For case-control studies, endometriosis was associated with increased risk of ectopic pregnancy with an OR of 2.66 (95% confidence interval [CI] = 1.14–6.21, p = .02). For cohort studies, the OR was 0.95 (95% CI = 0.29–3.11, p = .94), but after post hoc analysis of the studies with a Ottawa-Newcastle score ≥7, the OR was 2.16 (95% CI = 1.67–2.79, p <.001). For both case-control and cohort studies, there was high heterogeneity among studies (I2 = 93.9% and I2 = 96.6%, Q test p <.001) but no obvious evidence of systematic bias in the funnel plot, and Egger's test results were not significant (p = .35, p = .70), suggesting no strong publication bias. There were insufficient data to make any conclusions with respect to anatomic characteristics of endometriosis (e.g., stage) or mode of conception (e.g., assisted reproductive technology vs spontaneous).ConclusionPossible evidence of an association between endometriosis and ectopic pregnancy was observed (OR = 2.16–2.66). However, these results should be considered with caution, owing to high heterogeneity among studies. Continued research is needed to delineate the pregnancy implications of endometriosis. |
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