Ectopic Pregnancy
                             =================
þ Risks
 - "Damage to the fallopian tubes from pelvic inflammatory disease, previous 
   tubal surgery, or a previous ectopic pregnancy is strongly associated with an 
   increased risk of ectopic pregnancy. Minor risk factors include a history 
   of cigarette smoking, an age over 35 years, and many lifetime sexual 
   partners. There is no clear association between ectopic pregnancy and the 
   use of oral contraceptives, previous elective pregnancy termination, 
   miscarriage, or cesarean section. Conception with an intrauterine device 
   in place or after a tubal ligation is rare, but an estimated 25 to 50% of 
   such pregnancies are ectopic."
 - "Women who are subfertile are also at increased risk for an ectopic pregnancy 
   because altered tubal integrity (or function) contributes to both 
   conditions.8 In addition, the use of assisted reproductive techniques, 
   especially in vitro fertilization, increases the risk of ectopic pregnancy, 
   even among women who do not have damaged fallopian tubes. The risk of 
   heterotopic pregnancy also increases, from 1 case per 4000 women in the 
   general population to 1 case per 100 women who have undergone in vitro 
   fertilization. However, half of all women who receive a diagnosis of an 
   ectopic pregnancy do not have any known risk factors."
   "The risk of recurrence of ectopic pregnancy is approximately 10% among women 
   with one previous ectopic pregnancy and at least 25% among women with two or 
   more previous ectopic pregnancies."

   [Barnhart, K. T. (2009). "Clinical practice. Ectopic pregnancy." N Engl J Med 
   361(4): 379-387.]
 - previous ectopic
 - smoking
 - previous PID
 - present IUD? not any more they say
 - hx of infertility esp. if with treatment
 - tubal surgery
 - advanced maternal age
 - but 50% of patients with ectopics have no risk factors.
   [Brennan DF. Ectopic pregnancy - Part I: clinical and laboratory diagnosis.
   Acad Emerg Med 1995;2:1081-9.]
   [Jehle D, et al. Ectopic pregnancy. Emerg Med Clin North Am 1994;12:55-71.]

þ Diagnosis of Ectopic:
  <OB-HCG.TXT>

þ Methotrexate rather than surgery for ectopics:
  <OB-MTX.TXT>

þ Heterotopic Pregnancy (IUP+ectopic)
 - The incidence is 1/30,000 pregnancies. This number increases if the
   patient has had in vitro fertilization. Ref: General Gynecology p 441,

þ Ectopic and Tubal Ligation
 - One third of pregnancies occurring after a tubal ligation are ectopic
   pregnancies.  General Gynecology p 434-439.

þ Previous Ectopic
 - Patients who have had a prior ectopic pregnancy have up to a 25% risk of
   recurrence in subsequent pregnancies. General Gynecology p 434-439