Ectopic pregnancy in the United States 1970 through 1978.

ABSTRACT

Trends of the incidence and mortality associated with ectopic pregnancy (EP) in the United States were examined for 1970 through 1978. The estimated number of EPs rose from 17,800 in 1970 to 42,400 in 1978, and the EP incidence rate rose from 4.5 per 1,000 reported pregnancies to 9.4 during the same time period. The risk of EP was higher for older women and nonwhite women. Over 2.5% of all reported pregnancies among nonwhite women aged 35 to 44 years were ectopic. The death-to-case rate for EP declined almost 75% during the study period but remained consistently higher for nonwhite women as compared with white women.

ABSTRACT

PIP 2 data sets from the National Center for Health Statistics were examined to study national trends in the occurrence of ectopic pregnancy (EP). 2 estimates of EP occurrence were calculated from the National Hospital Discharge Survey 1) the number of EPs per 10,000 women aged 15-44 and 2) the number of EPs per 1000 reported pregnancies, which include EPs, legal abortions, and live births. From 1970-78, approximately 262,000 women aged 15-44 were discharged from US hospitals with a diagnosis of EP. The estimated number of EPs increased steadily from 17,800 in 1970 to 42,400 in 1978, while the EP rate/1000 reported pregnancies increased from 4.5 to 9.4. The EP rate/1000 reported pregnancies increased steadily with age, from 4.5 for women 15-25, 9.7 for women 25-34, to 15.2 for women 35-44. From 1970-78, the overall EP rate was 1.6 times higher for nonwhite than for white women. The EP rate for white women rose from 4.0/1000 reported pregnancies in 1970 to 8.4 in 1978, while for nonwhite women it rose from 7.1 to 12.5. The EP rate increased with age for both races. More than 1% of reported pregnancies in nonwhite women were ectopic; for nonwhite women aged 35-44 the rate was 2.6%. According to national vital statistics on mortality by cause, 437 women aged 15-44 died from EP between 1970 and 1978. The death-to-case rate declined more than 70% from 35 deaths/1000 EPs in 1970 to .9 in 1978. The death-to-case rate declined for both white and nonwhite women but remained consistenly higher for nonwhites. Overall the death-to-case rate for nonwhite women was 3.4 times that for white women. A likely cause of the marked increase in EP incidence between 1970-78 is pelvic inflammatory disease. Clinicians should consider the possibility of EP especially when treating nonwhite women over 35 who complain of menstrual irregularity and abdominal pain.