Uncovering the determinants of ectopic pregnancy: a case-control analysis in a tertiary care setting

Ectopic pregnancy (EP) is a major cause of maternal morbidity and mortality, particularly in the first trimester. Despite its clinical significance, data from the United Arab Emirates (UAE) remain scarce. This study aimed to identify determinants of EP among women attending a tertiary care hospital in Ajman, UAE. A hospital-based case-control study was conducted between January 2021 and January 2025. Medical records of 537 women were reviewed, comprising 134 cases with confirmed EP and 403 controls with intrauterine pregnancies of less than eight weeks. Sociodemographic, reproductive, and clinical data were retrospectively collected. Associations between potential risk factors and EP were examined using bivariate analysis, followed by multivariable logistic regression to adjust for confounders. Maternal age, gravida, parity, infertility history, and contraceptive use were not significantly associated with EP. Nationality showed a significant association, with women from the Eastern Mediterranean region demonstrating lower adjusted odds of EP (aOR 0.48; 95% CI: 0.25–0.91). A history of abortion (aOR 1.8; 95% CI: 1.09–2.98) and previous lower-segment cesarean section (aOR 1.7; 95% CI: 1.07–2.57) were independent predictors of EP. Prior ectopic pregnancy and abdominal or pelvic surgery were associated with EP in crude analysis but lost significance after adjustment. Acute abdominal pain was the most common presenting symptom. Ectopic pregnancy risk in this population is influenced by reproductive history, prior cesarean delivery, and nationality. Early risk stratification and targeted surveillance may facilitate timely diagnosis and reduce EP-related morbidity.