Current Trends Ectopic Pregnancy -- United States, 1987

Since 1970, CDC has monitored trends in ectopic pregnancy incidence and case fatality through the National Center for Health Statistics (NCHS). The National Hospital Discharge Survey, conducted by NCHS, collects data on ectopic pregnancies; information on ectopic pregnancy deaths is obtained from death certificate data compiled by NCHS. This report presents information on the number and rate of ectopic pregnancies and the case-fatality rate in the United States for 1987.

In 1987, approximately 88,000 women were hospitalized in the United States for ectopic pregnancy, an increase of 19% over the number reported for 1986 (Table 1). From 1970, when surveillance for ectopic pregnancy began, to 1987, the rate per 1000 reported pregnancies increased nearly fourfold (Figure 1). Similarly, the rate of ectopic pregnancies per 1000 live births rose almost fivefold, and the rate per 10,000 women of reproductive age (15-44 years old) increased almost fourfold.

In 1987, as in previous years, the highest rate of ectopic pregnancy per 1000 reported pregnancies occurred among women greater than or equal to 30 years of age (1). The rate was almost 40% higher for blacks and other minority groups than for whites. The rate was highest in the South and lowest in the Northeast.

In 1987, 30 women died as a result of ectopic pregnancy, six fewer than reported for 1986 (1). The case-fatality rate of 3.4 deaths per 10,000 ectopic pregnancies was 31% lower than the rate of 4.9 reported for 1986.

The risk for death associated with ectopic pregnancy decreased sharply from 1970 through 1976, then more gradually from 1977 through 1987 (Figure 2). From 1970 through 1987, the case-fatality rate decreased 90%--from 35.5 to 3.4 deaths per 10,000 ectopic pregnancies.

In 1987, the risk for death from ectopic pregnancy for blacks and other minority groups was almost twice that for whites. This difference represented a slight decline from 1986 and was substantially less than for 1984 and 1985, when the rate for blacks and other minority groups was four times that for whites (2). In 1987, case-fatality rates were lowest in the West and highest in the South; in 1986, the highest rates were in the Northeast. Reported by: Pregnancy and Infant Health Br and Statistics and Computer Resources Br, Div of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Complications from ectopic pregnancy are one of the two leading causes of maternal death in the United States. Potential reasons for the increasing incidence of ectopic pregnancy may include heightened awareness among medical providers, improved diagnostic technology, and increased occurrence of pelvic inflammatory disease resulting from sexually transmitted diseases (3). Early detection of ectopic pregnancy and subsequent interventions, both medical and surgical, may account for the continued decline in overall case-fatality rates (4-7).

A recent study of maternal mortality in the United States from 1979 to 1986 using multiple sources for case finding identified 10% more deaths from complications of ectopic pregnancy than did national vital statistics using only death certificate data for the same period. This finding suggests that all such deaths are not being reported. In 1987, CDC established the Prospective National Pregnancy Mortality Surveillance System, which uses multiple sources of data and which should enhance the ability to more completely ascertain deaths due to complications of ectopic pregnancy.

Until risk factors that lead to ectopic pregnancy are established and controlled, early detection will be the most effective means of reducing the morbidity and mortality associated with this condition. All women should be aware of the signs and symptoms of ectopic pregnancy so that they can enter the prenatal-care system as early as possible. Approximately 15% of women who have had an ectopic pregnancy and who conceive again will have another ectopic pregnancy (8). Emergency room and other physicians must consider and rule out ectopic pregnancy in the differential diagnosis of women of reproductive age who present with symptoms of pelvic and abdominal pain and amenorrhea with vaginal spotting or bleeding.

References

1. Lawson HW, Atrash HK, Saftlas AF, Finch EL. Ectopic pregnancy in the United States, 1970-1986. In: CDC surveillance summaries, September 1989. MMWR 1989;38(no. SS-2):1-10.

2. Lawson HW, Atrash HK, Saftlas AF, Franks AL, Finch EL, Hughes JM. Ectopic pregnancy surveillance, United States, 1970-1985. In: CDC surveillance summaries, December 1988. MMWR 1988;37(no. SS-5):9-18.

3. Chow JM, Yonekura ML, Richwald GA, Greenland S, Sweet RL, Schachter J. The association between Chlamydia trachomatis and ectopic pregnancy: a matched-pair, case-control study. JAMA 1990;263:3164-7.

4. Vermesh M. Conservative management of ectopic gestation. Fertil Steril 1989;51:559-67.

5. Stovall G, Ling F, Buster J. Outpatient chemotherapy of unruptured ectopic pregnancy. Fertil Steril 1989;51:435-8.

6. Garcia A, Aubert J, Sama J, Josimovich J. Expectant management of presumed ectopic pregnancy. Fertil Steril 1987;48:395-400.

7. Stabile I, Grudzinskas J. Ectopic pregnancy: a review of incidence, etiology and diagnostic aspects. Obstet Gynecol Surv 1990;45:335-47.

8. Hallatt JG. Repeat ectopic pregnancy: a study of 123 consecutive cases. Am J Obstet Gynecol 1975;122:520.

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