Ectopic pregnancy epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Moises Romo, M.D.
Overview
Ectopic pregnancy remains an important cause of death among all pregnancies. Drug abuse, unmarried status, no insurance, and had less than a high school education are factors associated with higher incidence of death. Ectopic pregnancies compose 1-2% of all pregnancies worldwide. In The United States, the incidence of ectopic pregnancy is 197 new cases per 100,000 persons. White females are more commonly affected, although, mortality rate is higher in those of black race.
Epidemiology and Demographics
Prevalence
- Ectopic pregnancy is a disease of short duration, immediately approached, hence difficult to calculate its prevalence.
- Around 1 in every 50 pregnancies in The United States are ectopic pregnancies.[1]
Incidence
- Worldwide, ectopic pregnancies occur in 1-2% of all pregnancies.
- In developing countries, the incidence of ectopic pregnancies range between 0.4% of all pregnancies in places such as Middle East and India, and over 4% reported in certain African countries, such as Ghana.
- In developed countries, such as The United States, the incidence of ectopic pregnancy is 197 new cases per 100,000 persons.
- Ectopic pregnancies are though to be as high as 4% in pregnancies involving assisted reproductive technology.[2]
Case Fatality Rate
- Ectopic pregnancies account for 3-4% of all pregnancy-related deaths in The United States.[3]
- Case-fatality rate has greatly decreased in The United States in the last decades, from 1.2 per 100,000 live births in 1980 to 0.5 per 100,000 live births in 2007.[4]
- Among the deaths from ectopic pregnancies in hospitalized women between 1998 and 2007, 70.5% were tubal pregnancies.[5]
- In lately years (2008-2010), from the women who died from ectopic pregnancies, 1.8 deaths per 100,000 live births died from hypovolemic shock from hemorrhage as compared with 0.3 deaths per 100,000 live births in 1999-2008.[6]
Age
- The rate of ectopic pregnancies is higher in women aged between 35-44.[7]
- Ectopic pregnancy mortality ratio was 3.5 times higher for women older than 35 years than those younger than 25 years during 2003-2007 in The United States.[5]
Gender
- Ectopic pregnancies, are unique to female gender.
Race
- Ectopic pregnancies usually affects women of black race more than others.[8] Asian women are less likely to develop ectopic pregnancies.[9]
- Ectopic pregnancy mortality ratio was 6.8 times higher in African Americans than their whites counterparts during 2003-2007 in The United States.[5]
Other factors
- Drug abuse, unmarried status, no insurance, and had less than a high school education were factors associated with higher incidence of death in patients with ectopic pregnancies.[6]
- A previous ectopic pregnancy, increases the risk of a second ectopic pregnancy by 15%.
Developed Countries
- In most of European countries and North America, the incidence of ectopic pregnancy has tripled over the past 30 years.[10]
- In developed countries, tubal damage resulting from infection or surgery, previous ectopic pregnancy, history of secondary infertility and treatment for in-vitro fertilization are rising risk factors for ectopic pregnancy.[11]
Developing Countries
- The diagnosis of ectopic pregnancy is especially challenging in developing countries before 7 weeks of amenorrhea, due to the poor access to ultrasound scans. It is often confused with miscarriage or induced abortion, an ovary problem, or with a PID.[12]
- In developing countries, surgery remains the mainstay of treatment, mostly performed by laparotomy rather than by laparoscopy.[12]
References
- ↑ Hoover KW, Tao G, Kent CK (March 2010). "Trends in the diagnosis and treatment of ectopic pregnancy in the United States". Obstet Gynecol. 115 (3): 495–502. doi:10.1097/AOG.0b013e3181d0c328. PMID 20177279.
- ↑ Kirk E, Bottomley C, Bourne T (2014). "Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location". Hum Reprod Update. 20 (2): 250–61. doi:10.1093/humupd/dmt047. PMID 24101604.
- ↑ Berg, Cynthia J.; Callaghan, William M.; Syverson, Carla; Henderson, Zsakeba (2010). "Pregnancy-Related Mortality in the United States, 1998 to 2005". Obstetrics & Gynecology. 116 (6): 1302–1309. doi:10.1097/AOG.0b013e3181fdfb11. ISSN 0029-7844.
- ↑ Creanga, Andreea A.; Shapiro-Mendoza, Carrie K.; Bish, Connie L.; Zane, Suzanne; Berg, Cynthia J.; Callaghan, William M. (2011). "Trends in Ectopic Pregnancy Mortality in the United States". Obstetrics & Gynecology. 117 (4): 837–843. doi:10.1097/AOG.0b013e3182113c10. ISSN 0029-7844.
- ↑ 5.0 5.1 5.2 Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM (April 2011). "Trends in ectopic pregnancy mortality in the United States: 1980-2007". Obstet Gynecol. 117 (4): 837–843. doi:10.1097/AOG.0b013e3182113c10. PMID 21422853.
- ↑ 6.0 6.1 "Ectopic Pregnancy Mortality — Florida, 2009–2010".
- ↑ Hoover KW, Tao G, Kent CK (March 2010). "Trends in the diagnosis and treatment of ectopic pregnancy in the United States". Obstet Gynecol. 115 (3): 495–502. doi:10.1097/AOG.0b013e3181d0c328. PMID 20177279.
- ↑ Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS (December 2014). "Ectopic pregnancy rates and racial disparities in the Medicaid population, 2004-2008". Fertil Steril. 102 (6): 1671–6. doi:10.1016/j.fertnstert.2014.08.031. PMC 4255335. PMID 25439806.
- ↑ Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM (April 2011). "Trends in ectopic pregnancy mortality in the United States: 1980-2007". Obstet Gynecol. 117 (4): 837–843. doi:10.1097/AOG.0b013e3182113c10. PMID 21422853.
- ↑ Storeide O, Veholmen M, Eide M, Bergsjø P, Sandvei R (April 1997). "The incidence of ectopic pregnancy in Hordaland County, Norway 1976-1993". Acta Obstet Gynecol Scand. 76 (4): 345–9. doi:10.1111/j.1600-0412.1997.tb07990.x. PMID 9174429.
- ↑ Pisarska MD, Carson SA, Buster JE (April 1998). "Ectopic pregnancy". Lancet. 351 (9109): 1115–20. doi:10.1016/S0140-6736(97)11476-3. PMID 9660597.
- ↑ 12.0 12.1 Goyaux N, Leke R, Keita N, Thonneau P (April 2003). "Ectopic pregnancy in African developing countries". Acta Obstet Gynecol Scand. 82 (4): 305–12. doi:10.1034/j.1600-0412.2003.00175.x. PMID 12716313.