Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease

Abstract

Objectives:We analysed the epidemiology of ectopic pregnancy (EP) during a 28 year period, 1970-97, using methods applicable to ecological studies in order to test the hypothesis that a reduction of pelvic inflammatory disease (PID) will be associated with a decrease of EP. Methods: Hospital records of patients aged 15-54 admitted to our department of gynaecology were reviewed for EP and PID for the period 1 January 1970 to 31 December 1997. EP for the period 1970-4 was based on available statistics. The total number for EP was 1270 and for PID 2559. The total population for the catchment area was 100 000-120 000 during the study period. Incidences were age standardised and calculated using oYcial population statistics to represent the average female population in the five 5 year periods 1970-4, 1975-9, 1980-4, 1985-9, 1990-4, and in each of the consecutive years 1995, 1996, and 1997. Incidences for EP were calculated per 1000 women and per 1000 pregnancies while those for PID per 1000 women. National statistical data of EP were available for 1975-94 and were used for comparison with the local study. Results: The EP incidences increased from 7.7 per 1000 pregnancies in the first 5 year period to 13.4 in the second, and continued to rise for another decade reaching the peak figures of 16.6 in 1985-9-that is, more than a twofold increase. Since then and to 1997 the EP incidence has decreased by 30%. PID admissions increased during the study period from 2.7 per 1000 women in the first 5 year period to 3.2 in the second. From then on they continuously decreased and reached a low of 0.5 in 1997. The greatest changes occurred in women <24 years of age. The peak incidence for this age group was 7.7 in 1975-9, and the lowest was 0.4 per 1000 women in 1996. The greatest reduction of EPs was noted for women <24 years old, from a high of 10.0 in 1975-9, coinciding with the peak incidence of PID, to a low of 4.0 in 1997, a reduction of 58.4%. The incidence of EP was two to three times higher in women >25 years old, most obvious in those >30 years, with peak figures of 20.9 per 1000 pregnancies in 1985-9, and 13.9 in 1997, a reduction of 33.4% and the lowest figures for the past 23 years. For women aged 25-29 years the incidence peaked in the previous 5 year period 1980-4-that is, one 5 year period later than for those <24 years, which we interpret as cohort eVects in relation to PID. Conclusions: Reduction of PID was strongly associated with a decline of EP. The decline was greater and immediate for women <24 years old, than for those >25 years. The two to three times higher EP incidence in women >25 years of age was most probably due to a cohort eVect as the peak of PID occurred a decade earlier in women <24 years old. Prevention of PID may not only reduce EP but also reduce adverse eVects on tubal patency. (Sex Transm Inf 2000;76:28-32)

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“…The incidence of ectopic pregnancy has plateaued at about 20 per 1,000 pregnancies in the early 1990s, according to the last time the CDC reported national data on ectopic pregnancy [2]. This trend is also consistent with the incidence of pelvic inflammatory disease attributed to both chlamydia and gonorrhea as similar in our institution [3]. Other risk factors such as prior surgeries, multiple sexual partners, and smoking are also common in our hospital population.…”

Analysis of ectopic pregnancy at a tertiary care hospital: one year study

“…2 Some associated risk factors are considered to be partially responsible for escalation of ectopic pregnancy, like dramatic rise in STIs and the popularity of intrauterine devices (IUD) leading to PID and iatrogenic induced complications which result from increase in use of assisted reproductive technologies (ART). 3,4 High resolution ultrasonography (USG) and serum beta subunit of human chorionic gonadotrophin (-HCG) level are helpful for early detection of ectopic pregnancy in unruptured state as the doubling of serum -HCG which normally occur in approximately 48 hours is not seen in cases of ectopic pregnancy. Early diagnosis allows options for treatment by minimally invasive surgery or medical treatment under care of skilled personnel.…”

Laboratory? or Fertility? in Ectopic Pregnancy Management

“…(5). Bu yükselen insidans, şiddetli pelvik inflamatuar hastalık (PID) insidansındaki artış ile ilişkilidir (6). Ektopik gebelik olgularının 25-35 yaş arasında daha sık olduğu, ancak riskin ilerleyen yaşla 3-4 katına çıktığı gösterilmiştir (5,7).…”