Epidemiology of Ectopic Pregnancy

The epidemiology of ectopic pregnancy, both the numbers and rates of which have tripled in the U.S. from 1970 to 1983, is analyzed here. Ectopic pregnancy includes all implantations other than in the anatomically normal uterine cavity. Improved ascertainment and earlier diagnosis, due to ultrasound and beta-hCG assays, have probably raised reported numbers of cases. On the other hand, there has been a parallel climb in incidence of pelvic inflammatory disease, thought to be associated with ectopic pregnancy. Rates were higher among women over 35, black, or previously married, although similar in various regions of the country. Mortality from ectopic pregnancy has become the most common cause of maternal death, replacing mortality resulting from illegal abortion. Despite this, death from ectopic pregnancy fell 7-fold, to 0.5 per 1000 ectopic pregnancies, or 40-50 per year nationally in 1983. Ectopic pregnancy was 3 times as risky for blacks as whites, 10 times as dangerous as childbirth, and 50 times as deadly as legal abortion. Some factors acting in the fatalities included delay of treatment (53%) and misdiagnosis (almost half).