A CASE-CONTROL STUDY OF SEROLOGICAL EVIDENCE OF PRIOR CHLAMYDIA TRACHOMATIS INFECTION IN PATIENTS WITH ECTOPIC PREGNANCY IN ILORIN

Abstract

BACKGROUND: Ectopic pregnancy is one of the most serious sequelae to acute salpingitis. Chlamydia trachomatis has been reported to be the most common etiological agent of acute salpingitis. However, little is known about the role of Chlamydia trachomatis in the etiology of ectopic pregnancy in Nigeria.OBJECTIVE: To determine the prevalence of antibodies to Chlamydia trachomatis in women presenting with ectopic pregnancy in Ilorin, with a specific objective of establishing an aetiological role for Chlamydia trachomatis infection as a risk factor for ectopic pregnancy in Nigerian women.

STUDY DESIGN: A prospective case-control observational study
SETTING: The study was conducted in eight hospitals within Ilorin metropolis. These were made up of a tertiary health institution, a state general hospital, and six private hospitals.
SUBJECTS: The study population was made up of 48 women with ectopic pregnancy, confirmed at laparotomy, while the control group was made up of 48 women with ultrasound confirmed normal first and early second trimester intrauterine pregnancy.
METHODS: Both study and control group women underwent a structured interview giving particular attention to sociodemographic variables, sexual and reproductive history, contraception history, past history suggestive of pelvic infection and their health seeking behaviour, and history of previous ectopic pregnancy. The levels of serum IgG antibody to Chlamydia trachomatis in all the women were determined.
MAIN OUTCOME: The prevalence of serum antichlamydia antibody in women with ectopic pregnancy (70.8%) was significantly higher compared with women with normal intrauterine pregnancy (37.5%). The prevalence was higher in women with ectopic pregnancy who were below age 30years (82.6%) when compared with the prevalence in women with ectopic pregnancy who were 30 years and above (60%), and also higher in women who had no other readily identifiable risk factors for ectopic pregnancy (73.8%) compared to women in whom other risk factors are present (50%). The results also showed that women with ectopic pregnancy were more likely to be unmarried, of low educational status, of low parity, have sexual debut at younger age, have multiple sexual partners and inconsistent user or non-user of condoms and oral contraceptive pill when compared with women with normal intrauterine pregnancy.

CONCLUSION: The study highly suggests that among women in Ilorin, prior Chlamydial trachomatis infection is associated with an increased risk of ectopic pregnancy. We suggest that an effective way of dramatically reducing the ectopic pregnancy rate is by prevention of Chlamydial infection.

A CASE-CONTROL STUDY OF SEROLOGICAL EVIDENCE OF PRIOR CHLAMYDIA TRACHOMATIS INFECTION IN PATIENTS WITH ECTOPIC PREGNANCY IN ILORIN