In 1986, 73,700 ectopic pregnancies* were reported in the United
States, a 6% decrease from the number reported in 1985 (not
statistically significant) (Table 1) (1,2). From 1970, when
surveillance of ectopic pregnancy began, to 1986, the rate per 1000
reported pregnancies more than tripled, from 4.5 to 14.3 (Figure
1).
Similarly, the rate of ectopic pregnancy per 1000 live births rose
fourfold, from 4.8 in 1970 to 19.7 in 1986, and the rate per 10,000
females of reproductive age (15-44 years) more than tripled, from
4.2
per 10,000 in 1970 to 12.8 in 1986.
In 1986, as in previous years, the highest rates of ectopic
pregnancies (per 1000 reported pregnancies) occurred among women
greater than or equal to 30 years of age (3). Rates were 60% higher
among women of black and other minority races than among white
women.
When analyzed by geographic region, the highest rates of ectopic
pregnancy occurred in the South, the same as in 1985. The lowest
rates
for 1986 occurred in the Midwest.
In 1986, 36 women died as a result of ectopic pregnancy,**
compared
with 33 in 1985. The case-fatality rate of 4.9 deaths per 10,000
ectopic pregnancies represented a 17% increase over the rate of 4.2
reported in 1985.
The risk of death associated with ectopic pregnancy decreased
sharply
from 1970 through 1976, and more gradually from 1977 through 1986
(Figure 2). Overall, the case-fatality rate decreased more than
86%,
from 35.5 deaths per 10,000 ectopic pregnancies in 1970 to 4.9 in
1986.
In 1986, the risk of dying from ectopic pregnancy was more than
two
times higher in women of black and other minority races than in
white
women, representing a decrease in the racial disparity noted in the
previous 2-year period. In 1986, case fatality rates were highest
in
the Northeast and lowest in the West; in 1985, the highest rates
were
also in the Northeast, but the lowest rates were reported in the
Midwest.
Reported by: Pregnancy Epidemiology Br, Research and Statistics Br,
Div
of Reproductive Health, Center for Chronic Disease Prevention and
Health Promotion, CDC.
Editorial Note
Editorial Note: Complications from ectopic pregnancy remain one of
the
leading causes of maternal death in the United States. Factors that
may
have contributed to the decrease in the number of women
hospitalized
for ectopic pregnancies include heightened awareness of this
condition
and improved diagnostic technology. Newer technology has led to
earlier
diagnosis of ectopic pregnancy and to the use of more conservative
methods, not requiring hospitalization, for managing the condition
(4-6). The increase in case-fatality rate in 1986 reflects the
simultaneous increase in the number of deaths and a decrease in the
number of ectopic pregnancies and may represent more complete
ascertainment of deaths. In a study initiated in 1988, CDC
continues to
investigate the possible causes of ectopic pregnancy. National
pregnancy mortality surveillance initiated in 1987 is directed
toward
identifying and investigating all pregnancy-associated deaths by
using
multiple sources of reporting and information.
References
National Center for Health Statistics, Graves EJ. Utilization of
short-stay hospitals, United States, 1985. Hyattsville, Maryland:
US
Department of Health and Human Services, Public Health Service,
1987:55; DHHS publication no. (PHS)87-1752. (Vital and health
statistics; series 13, no. 91).
2. National Center for Health Statistics, Graves EJ. Utilization
of
short-stay hospitals, United States: 1986 annual summary.
Hyattsville,
Maryland: US Department of Health and Human Services, Public Health
Service, 1988:55; DHHS publication no. (PHS)88-1757. (Vital and
health
statistics; series 13, no. 96).
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; 37(no. SS-5):9-18.
Vermesh M. Conservative management of ectopic gestation. Fertil
Steril 1989;51:559-67.
Garcia AJ, Aubert JM, Sama J, Josimovich JB. Expectant
management of
presumed ectopic pregnancies. Fertil Steril 1987;48:395-400.
*Data on the numbers of ectopic pregnancies were obtained from the
National Hospital Discharge Survey conducted by the National Center
for
Health Statistics, CDC.
**Ectopic pregnancy mortality data are based on U.S. vital
statistics
collected by the National Center for Health Statistics, CDC.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
