In 1984, 75,400 ectopic pregnancies* were reported in the United
States, representing an increase of 8% over the number reported in
1983
(Table 1). In 1985, the number of ectopic pregnancies increased to
78,400, a 4% increase from the previous year. From 1970, when
surveillance for ectopic pregnancy began, to 1985, the rate per
1000
reported pregnancies** more than tripled from 4.5 to 15.2 (Figure
1).
Similarly, the rate of ectopic pregnancies per 1000 live births
increased fourfold from 4.8 in 1970 to 20.9 in 1985, while the rate
per
10,000 females of reproductive age (15-44 years) more than tripled
from
4.2 in 1970 to 14.0 in 1985.
In 1984 and 1985, the highest rates of ectopic pregnancies (per
1000
reported pregnancies) occurred for women greater than or equal to
30
years of age, as in previous years (1). Rates were approximately
50%
higher for women of black and other races than for white women.
Preliminary analysis by geographic region for 1984 and 1985 showed
the
highest rates of ectopic pregnancies in the Midwest and South,
whereas
in 1981-1983 the highest rates occurred in the West. For both time
periods, the lowest rates occurred in the Northeast.
In 1984, 39 women died because of ectopic pregnancy.*** The
case-fatality rate of 5.2 deaths per 10,000 ectopic pregnancies was
similar to that of 5.3 in 1983. In 1985, 33 women died because of
ectopic pregnancy, a case-fatality rate of 4.2.
Ectopic pregnancy-associated deaths decreased sharply from 1970
through 1976, then declined more gradually from 1977 through 1985
(Figure 2). The overall case-fatality rate decreased more than
eightfold, from 35 deaths per 10,000 ectopic pregnancies in 1970 to
4.2
in 1985. During 1984 and 1985, women of black and other races had a
fourfold higher risk for ectopic pregnancy-related death than did
white
women. The racial disparity in case-fatality rates has increased
since
1981-1983, when threefold higher rates were reported for women of
black
and other races. In 1984, as in 1981-1983, case-fatality rates were
highest in the South and lowest in the West. In 1985, however, they
were highest in the Northeast and lowest in the Midwest.
Reported by: Pregnancy Epidemiology Br, Research and Statistics Br,
Div
of Reproductive Health, Center for Health Promotion and Education,
CDC.
Editorial Note
Editorial Note: The reasons for the increasing incidence of
ectopic
pregnancy are not known. However, improved diagnosis (2),
heightened
awareness among physicians, the increased occurrence of pelvic
inflammatory disease associated with sexually transmitted diseases
(3),
and the tendency of women to delay childbearing until later in
reproductive life, when the risk of an ectopic pregnancy is
greatest
(4), may all have a bearing. An association between induced
abortion
and ectopic pregnancy has been hypothesized but not documented with
existing U.S. data (2). CDC is conducting a study to investigate
the
possible etiologies of ectopic pregnancy. Earlier detection of
ectopic
pregnancies and subsequent interventions may also account for the
steady decline in case-fatality rates.
In January 1988, CDC implemented the National Pregnancy Mortality
Surveillance. The objectives of this new surveillance system are to
identify and investigate all pregnancy-associated deaths using
multiple
sources of reporting and information, thus ensuring more complete
ascertainment of all pregnancy-associated deaths, in- cluding those
due
to ectopic pregnancies.
References
Atrash HK, Hughes JM, Hogue CJR. Ectopic pregnancy in the
United
States, 1970-1983. In: CDC surveillance summaries, Aug. 1986. MMWR
1986;35(no. 2SS):29SS-37SS.
Chow W-H, Daling JR, Cates W Jr, Greenberg RS. Epidemiology of
ectopic pregnancy. Epidemiol Rev 1987;9:70-94.
Washington AE, Cates W Jr, Zaidi AA. Hospitalizations for pelvic
inflammatory disease: epidemiology and trends in the United States,
1975 to 1981. JAMA 1984;251:2529-33.
Baldwin WH, Nord CW. Delayed childbearing in the United States:
facts and fictions. Popul Bull 1984;39:3-42.
*Data were obtained from the National Hospital Discharge Survey
conducted by the National Center for Health Statistics (NCHS), CDC.
**Includes live births, legally induced abortions, and ectopic
pregnancies.
***Ectopic pregnancy mortality data were obtained from death
certificate data compiled by NCHS.
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