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Ectopic Pregnancy -- United States, 1984 and 1985

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

  1. 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.

  2. Chow W-H, Daling JR, Cates W Jr, Greenberg RS. Epidemiology of ectopic pregnancy. Epidemiol Rev 1987;9:70-94.

  3. 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.

  4. 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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