Ectopic pregnancy after hysterectomy study: A systematic review of published case reports comparing ectopic pregnancy following total and supracervical hysterectomy

Purpose

To perform a systematic review of all published case reports and compare ectopic pregnancy following total versus supracervical hysterectomy.

Methods

Published case reports of patients with ectopic pregnancy following hysterectomy up to July 12, 2024, were searched using PubMed, Google Scholar, Embase, Scopus, and Web of Science databases using the terms “post-hysterectomy ectopic pregnancy,” OR “pregnancy after hysterectomy.” Manuscripts with case reports of ectopic pregnancy following previous hysterectomy were statistically analyzed. Categorical variables were analyzed using the chi-squared or Fisher's exact test and continuous variables by independent t-test and Wilcoxon rank sum test. A p-value <0.05 determined statistical significance.

Main Results

One hundred and eight cases reported by 106 authors were eligible for analysis. Of these, 34 underwent supracervical and 74 total hysterectomies. There were no differences between the two groups in the demographic variables, symptoms, and status of patients at presentation. Patients with a history of supracervical, unlike total hysterectomy, were less likely to have their pregnancy associated with the period just before or shortly after hysterectomy (termed the peri-hysterectomy period) (OR 0.18, 95% CI [0.06–0.54], p < 0.001). However, they are more likely to have a diagnosis of possible ectopic pregnancy before surgery (OR 3.56, 95% CI [1.45–8.73], p = 0.007).

Conclusion

Physicians should be aware that ectopic pregnancy following a supracervical, unlike total hysterectomy, occurs more often remote from the peri-hysterectomy period and should include ectopic pregnancy in their differential diagnosis of abdominal and pelvic pain in all previously hysterectomized patients.