Ectopic Pregnancy -- United States, 1988-1989

Although the number and rate of ectopic pregnancies in the United States increased from 1970 through 1987, they stabilized from 1987 through 1989 (1). This report presents data regarding the number and rate of ectopic pregnancies and ectopic pregnancy-related deaths in the United States from 1988 through 1989 and compares those data with information reported since 1970.

Data were obtained from the National Hospital Discharge Survey (NHDS), conducted by CDC's National Center for Health Statistics (NCHS). Information on deaths was obtained from death certificate data compiled by NCHS. Estimates of hospitalization for ectopic pregnancy are rounded to the nearest 100.

During 1989, an estimated 88,400 (95% confidence interval (CI)=70,600-106,100) U.S. women were hospitalized for ectopic pregnancy, a 10% increase over the 1988 estimate of 80,700 (95% CI=67,200-94,200) but approximating the estimate for 1987. From 1970 (when surveillance of ectopic pregnancy began) through 1989, the rate of ectopic pregnancies per 1000 reported pregnancies* increased almost fourfold, from 4.5 to 16.1 (Table 1). Similarly, the rate of ectopic pregnancies per 1000 live births increased almost fivefold, from 4.8 to 22.0, while the rate per 10,000 reproductive-aged women (aged 15-44 years) increased more than threefold, from 4.2 to 15.5 (Table 1).

From 1988 through 1989, the highest rate of ectopic pregnancy occurred for women aged greater than or equal to 30 years, the same as in previous years (1). The rate for black and other minority women was 32% higher than that for white women. When rates were calculated by geographic region, the highest rate of ectopic pregnancy occurred in the South**, the same as reported during 1985-1987 (1,2); the lowest rate occurred in the Midwest.

Although the risk for death associated with ectopic pregnancy decreased from 1970 through 1987 (Figure 1), slight increases occurred in 1988 and 1989. From 1970 through 1989, the case-fatality rate decreased 90%, from 35.5 to 3.8 deaths per 10,000 ectopic pregnancies.

In 1988, 44 women died from complications of ectopic pregnancy *** -- 14 more than reported in 1987 (1) (case-fatality rate: 5.4 deaths per 10,000 ectopic pregnancies). In 1989, 34 deaths occurred as a result of ectopic pregnancy complications (case-fatality rate: 3.8 deaths per 10,000 ectopic pregnancies).

For black women and women in other minority groups, the risk for death from ectopic pregnancy was more than three times that for white women in 1988 and almost five times the risk in 1989. The racial disparity during 1988 and 1989 increased from figures reported in 1986 and 1987 and was similar to figures reported from 1983 through 1985 (2) -- when fourfold higher rates occurred among black women and women in other minority groups (Figure 1).

Reported by: Pregnancy and Infant Health Br, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: In the United States, complications from ectopic pregnancy are the leading cause of pregnancy-related death during the first trimester (3,4). Factors accounting for the decreased occurrence of ectopic pregnancy in 1988 include heightened awareness of ectopic pregnancy among health-care providers and patients, earlier diagnosis, and more frequent use of conservative ambulatory therapy (5-8). In addition, this decrease may also reflect changes in the NHDS sampling frame implemented in 1988. However, variability of the data, as indicated by wide confidence intervals, does not permit meaningful conclusions about changes in the estimates of ectopic pregnancies for 1988 and 1989.

The increase in case-fatality rates in 1988 resulted from the simultaneous increase in the number of deaths reported and the decrease in the estimated number of women hospitalized with ectopic pregnancy. Although the race-specific risk for death associated with ectopic pregnancy requires further assessment, all rates employing race-specific estimates must be interpreted cautiously because race was unreported for almost 10% of ectopic pregnancy cases during the time interval of the report.

CDC is analyzing data from a case-control study that will increase knowledge about risk factors for ectopic pregnancies among a predominantly black population. In addition, CDC will be analyzing data from the National Prospective Maternal Mortality Surveillance System, initiated in 1987, to assess deaths due to complications of ectopic pregnancy during 1987-1990.

References

1. Nederlof KP, Lawson HW, Saftlas AF, Atrash HK, Finch EL. Ectopic pregnancy surveillance, United States, 1970-1987. In: CDC surveillance summaries, December 1990. MMWR 1990;39(no. SS-4):9-17.

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

3. Leach R, Ory S. Management of ectopic pregnancy. Am Fam Physician 1990;41:1215-22.

4. Ory S. New options for diagnosis and treatment of ectopic pregnancy. JAMA 1992;267:534-7.

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

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

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

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

• Includes live-born infants, legally induced abortions, and ectopic pregnancies. ** Regions defined by the Bureau of the Census. *** Ectopic pregnancy mortality data were obtained from death certificate data compiled by NCHS.

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