Which of the following is the strongest established risk factor for tubal ectopic pregnancy?
- A Previous pelvic inflammatory disease due to Chlamydia trachomatis ✓
- B Use of a copper intrauterine device
- C Combined oral contraceptive use
- D Smoking more than 20 cigarettes per day
Correct answer: A. Previous pelvic inflammatory disease due to Chlamydia trachomatis
Explanation
Chlamydial salpingitis causes tubal mucosal damage and ciliary loss, producing the highest attributable risk for tubal ectopic gestation. B copper intrauterine device actually prevents intrauterine pregnancy more effectively than ectopic pregnancy, so the absolute number of ectopics falls, though the proportion that are ectopic rises if pregnancy occurs. Combined oral contraceptives reduce ovulation and lower overall ectopic risk. Smoking raises risk modestly but far less than prior salpingitis.
Reference: Novak's Gynecology, 16th ed.
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Written and medically reviewed by the StethoPrep medical team.