Temporal trends in severe morbidity and mortality associated with ectopic pregnancy requiring hospitalisation in Washington State, USA: a population-based study

Abstract

ObjectiveTo examine temporal trend in maternal mortality/severe morbidity associated with hospitalisation due to ectopic pregnancy.DesignA population-based observational study.Setting and participantsAll women hospitalised for ectopic pregnancy in Washington State, USA, 1987–2014 (n=20 418). The main composite outcome of severe morbidity/mortality included death, sepsis, need for transfusion, hysterectomy and systemic or organ failure, identified by diagnostic and procedure codes from hospitalisation files. Severe morbidity/mortality due to ectopic pregnancy were expressed as incidence ratios among women of reproductive age (15–64 years) and among women hospitalised for ectopic pregnancy. Comparisons were made between 1987–1991 (reference) and 2010–2014 using ratios of incidence ratios (RR) and ratio differences (RD). The Cochran-Armitage test for trend assessed statistical significance; logistic regression was used to obtain adjusted OR (AOR) and 95% CI, adjusted for demographic factors and comorbidity.ResultsHospitalisation for ectopic pregnancy declined from 0.89 to 0.16 per 1000 reproductive age women between 1987–1991 and 2010–2014 (p<0.001). Among reproductive age women, ectopic pregnancy mortality remained stable (0.03 per 100 000); and mortality/severe morbidity increased among women aged 25–34 years (p=0.022). Among women hospitalised for ectopic pregnancy, mortality increased from 0.29 to 1.65 per 1000 between 1987–1991 and 2010–2015 (p=0.06); severe morbidity/mortality increased from 3.85% to 19.63% (RR=5.10, 95% CI 4.36 to 5.98; RD=15.78 per 100 women, 95% CI 13.90 to 17.66; AOR for 1-year change was 1.08, 95% CI 1.07 to 1.08).ConclusionsHospitalisation for ectopic pregnancy declined in Washington State, USA, between 1987 and 2014; however, mortality/severe morbidity associated with ectopic pregnancy increased in female population aged 25–34 years.

Ectopic pregnancy in Rivers State University Teaching Hospital, Port Harcourt, southern Nigeria: a five- year review

“…The implantation of a fertilized ovum on a site other than the endometrial lining of a normal uterine cavity is referred to as ectopic pregnancy [1][2][3]. It is one of the most common gynaecological admissions worldwide and of public health importance [4][5][6].…”

“…Ectopic pregnancy is a gynaecological emergency that is associated with increased morbidity and mortality if not promptly diagnosed and managed appropriately. It accounts for 75% of maternal mortality in early pregnancy [3]. Although ectopic pregnancy can occur in the ovaries, cervix, and abdominal cavity, fallopian tube is the commonest site of occurrence and accounts for about 98% of cases of ectopic pregnancy [1,4].…”

“…The incidence of ectopic pregnancy varies from country to country and among centres [3]. In the United States of America (USA), the incidence of ectopic pregnancy ranges from 1 in 280 to 1 in 241 deliveries [5], with an estimated health care cost of US$1 billion annually [3]. The incidence is higher in developing countries compared to developed countries [4,5].…”

“…The incidence is higher in developing countries compared to developed countries [4,5]. Studies have shown that the incidence is on the increase over the years [2][3][4][5][6]. This may be due to the number of pelvic infections among women of reproductive age group, improved diagnostic technique, and increase in the use of ovulation induction drugs as well as assisted reproductive techniques [2,3,6].…”

Causes of Maternal Mortality in Tehran, Iran

“…EP was the death cause in 5.7% of cases. EP-induced mortality rate is also high -even in developed countries-which may be in part due to recent growing tendency toward conservative outpatient treatments of EPs [12]. In addition, the rate of malpractices in the management of EPs in Iran is considerable [13].…”