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Ectopic Pregnancy -- United States, 1986

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

  1. 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).

  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; 37(no. SS-5):9-18.

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

  4. Stovall TG, Ling FW, Buster JE. Outpatient chemotherapy of unruptured ectopic pregnancy. Fertil Steril 1989;51:435-8.

  5. 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.

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