Risk - Ectopic Pregnancy

The three-to-fourfold rise in the incidence of ectopic pregnancy coincides almost exactly with the steep rise in the frequency of induced abortion.
  • If an ectopic pregnancy is not diagnosed it can rupture, resulting in severe abdominal pain, bleeding, and sometimes even death
  • The higher risk could be resulting from injuries, inflammations, and infections resulting from the scraping and suctioning of a woman's uterus in a surgical abortion.
  • Even with other risk factors eliminated, women who have previously aborted have a 50% higher risk of ectopic pregnancy.
  • Where there are two or more abortions, the risk increases to 90%.
  • Women have gone home following an "abortion" to later die from a ruptured tube.
An ectopic/tubal pregnancy occurs when a fertilized egg is implanted outside the uterus, typically in one of the Fallopian tubes.

Once conception occurs, the fertilized egg usually takes about four to five days to travel down the tube from the ovary to the uterus.

If the tube is damaged or blocked, or fails to propel the egg toward the uterus, the egg may become implanted in the wall of the tube and continue to develop there.

Occasionally it may implant in another part of the abdomen, in an ovary, or in the cervix. In rare cases, an ectopic pregnancy and a normal pregnancy in the uterus occur at the same time.

About one of every 50 known pregnancies is ectopic (meaning literally, "out of place"). Surgeons are unable to transplant an ectopic pregnancy into the uterus, so the pregnancy must be terminated.

In fact, if an ectopic pregnancy is not recognized and treated in time, the embryo will grow until it causes the tube to rupture, resulting in severe abdominal pain, bleeding, and sometimes even death. Most ectopic pregnancies are caught in time, but the condition still causes about 50 deaths in the United States each year.

Abortion is significantly related to an increased risk of subsequent ectopic pregnancies.
Abortion is significantly related to an increased risk of subsequent ectopic pregnancies. Ectopic pregnancies, in turn, are life threatening and may result in reduced fertility.

Between 1970 and 1990 the rate of ectopic pregnancies doubled, trebled or quadrupled in frequency, depending on the country. They now account for two per cent of all pregnancies in the areas studied. The rise of ectopic pregnancy coincides almost exactly with the steep rise in the frequency of induced abortion during the same period.

Studies from Italy, Japan, Yugoslavia and the U.S. have documented a much higher risk of ectopic pregnancy among women who have had one or more abortions. Yet the authors of an American study that uncovered a 160 per cent increased risk arrived at the curious conclusion that abortion "does not carry a large excess risk" of ectopic pregnancy. (American Journal of Public Health 72 (1982):253-6)

That legal abortion appears to contribute to an increase in ectopic pregnancy in younger women, when associated with pelvic inflammatory disease, was the finding of a study published in the American Journal of Obstetrics & Gynecology in 1989.

French Study
Publishing in the American Journal of Public Health, a team of French doctors and researchers reported the results of a multi-centre study involving 1,955 women conducted in two regions of France between 1988 and 1991.

All women, younger than 45, admitted into maternity centers for ectopic pregnancy, in the Paris area, in 1988 and in fifteen maternity centres in the Rhone-Alps area, between 1989-1991, were paired with the next two patients admitted to those same centers for regular deliveries.

Women who had previously had at least one induced (surgical) abortion were 50% more likely to develop an ectopic pregnancy than women who had not had a previous abortion.
According to the report, the authors found that among women each of whom had no previous ectopic pregnancy, women who had previously had at least one induced (surgical) abortion were 50% more likely to develop an ectopic pregnancy than women who had not had a previous induced abortion. Among women who had had two or more previous induced abortions and no previous ectopic pregnancy, the risk was nearly twice as high (90% increased risk).

The authors of the study say there has been a three to fourfold rise in the incidence of ectopic pregnancy in developed countries in the last 20 years. Several risk factors for ectopic pregnancy have been identified, among them smoking at the time of conception, pelvic surgery, use of an IUD, pelvic inflammatory disease, and induced ovulation.

Yet these factors, according to an earlier French study by many of the same researchers, accounted for only about 65% of all ectopic pregnancies. The 1988-91 study was initiated to determine if other factors, such as previous reproductive history, might explain some of the remaining one-third of ectopic pregnancies among women without any of these known risk factors.

Even the most basic analysis offers solid grounds for making the association.
Even the most basic analysis offers solid grounds for making the association. Twenty-two and one-half percent of the case patients (those presenting to the maternity centres with an ectopic pregnancy) had had abortions, while only 16.2% of the controls (those women reporting for a delivery to those same centers immediately after a woman with an ectopic pregnancy had been admitted) reported having an abortion.

Even with other risk factors and the possibility of the controversial idea of recall bias (women not wanting to admit having had an abortion) factored out, the discrepancy remained. Women who had previously aborted had a 50% higher risk.

The authors speculate that the higher risk could be "the consequence of uterine injuries consecutive to this procedure, either inflammatory lesions or asymptomatic ascending infections," in other words, due to injuries, inflammations, and infections resulting from the scraping and suctioning of a woman's uterus in a surgical abortion.

Inflammations or lesions following a surgical abortion may damage the Fallopian tube, inhibiting the transport of the embryo.
These inflammations or lesions may damage the Fallopian tube, inhibiting the transport of the embryo. Instead of implanting in the uterine wall, the embryo implants in the Fallopian tube.

Despite the prevalence of abortion in the United States, there have been few studies on American populations. Some have shown a similar risk, but most, the authors say, "have not revealed any significant association." (Daling) Dr Daling suggested that larger numbers of women need to be studied in order to achieve more accurate results.

The French researchers agreed, saying the US studies "generally have not included enough subjects to allow satisfactory statistical power."

The size and design of the French study implies that an association exists between abortion and ectopic pregnancy.

Abortion is the subject of much bias.
Politics
Abortion is the subject of much bias. As in the case with breast cancer and the link with abortion, whether or not studies are accepted or rejected is almost predetermined. 'Political correctness' demands that studies not be done if there is sufficient reason to suspect that the conclusions would challenge the safety of abortion.

It is, unfortunately, not uncommon for abortion researchers to make misleading statements in the abstracts (ie. a statement summarizing the important points of a text) or conclusions (result of their findings) of their articles that flatly contradict their actual findings.

The French study presents a strong case for informed consent or "women's right to know" legislation in those countries that do not already have such laws. If this study is correct, a woman who aborts her baby may find that she is unable to carry future pregnancies to term.

Informed Consent
Patients are entitled by law to be fully informed of the possible risks involved with medical treatment. In New Zealand this right comes under The Code of Health and Disability Services Consumers Rights. (See Informed Consent for more on this subject.)
In NZ, medical professionals could face complaint proceedings for breaches to the Code of Health and Disability Services
Consumers' Rights.

In NZ Law on Abortion, it is explained how NZ medical professionals could face complaint proceedings for breaches to the Code of Health and Disability Services Consumers’ Rights.

Missed diagnoses
It is not uncommon for a woman to be diagnosed as having had a miscarriage when in fact she has an ectopic pregnancy. Often, following an ultrasound that fails to find an embryo, a woman experiences further pain and seeks emergency help, which is when she is diagnosed as having an ectopic pregnancy.

This also happens following an abortion.

Women have been known to have had a vacuum aspiration "abortion," when in reality the tiny foetus is still lodged in the tube. In some cases the tube ruptures and women have died as a result.

RESOURCES
Daling,et.al., "Ectopic Pregnancy in Relation to Previous Induced Abortion", JAMA, 253(7):1005-1008 (Feb. 15, 1985);
Ann A. Levin, et al., "Ectopic Pregnancy and Prior Induced Abortion," American Journal of Public Health 72 (March 1982): 253-256.
C.S. Chung, "Induced Abortion and Ectopic Pregnancy in Subsequent Pregnancies," American Journal of Epidemiology 115(6):879-887 (1982)
Anna Kalandidi, et al., "Induced Abortions, Contraceptive Practices, and Tobacco Smoking as Risk Factors for Ectopic Pregnancy in Athens, Greece," British Journal of Obstetrics and Gynecology Vol. 98, No. 2 (1991): 207-13;
Rubin et al., "Fatal Ectopic Pregnancy After Attempted Induced Abortion," JAMA, vol. 244, no. 15, Oct. 10, 1980 H. Atrash et al., "Ectopic Preg. Concurrent With Induced Abortion"; Am. J. OB-GYN, Mar. ’90, p. 726