Management of Unintended and Abnormal Pregnancy : Comprehensive Abortion Care

Ectopic pregnancy occurs when a fertilized ovum implants outside the endometrial cavity, most commonly in the fallopian tube [1]. The exact incidence of ectopic pregnancy is difficult to determine. Traditional methods of measuring rates of ectopic pregnancy, such as the use of hospital records, are no longer accurate due to the increasing numbers of ectopic pregnancies managed in outpatient settings. Using US national survey data on inpatient admissions and visits to hospital emergency and outpatient departments, the Centers for Disease Control and Prevention (CDC) estimated that ectopic pregnancy accounted for 2% of all pregnancies (19.7 per 1,000 reported pregnancies) in the USA in 1992. Because this analysis did not include patients managed exclusively in physicians’ offices, the true incidence of ectopic pregnancy is undoubtedly greater. Although the number of US women hospitalized for ectopic pregnancy has decreased over time, data suggest that the incidence of ectopic pregnancy increased sixfold from 1970 to 1992 [2]. For unclear reasons, studies have consistently reported lower rates of ectopic pregnancy (less than 1%) in women presenting for induced abortion [3,4]. Ectopic pregnancy remains an important cause of mortality and morbidity in women of reproductive age. In the 1990s, ectopic pregnancy accounted for 6% of all pregnancy-related deaths in the USA [5]. Although the mortality rate from ectopic pregnancy declined from 84.2 deaths per 100,000 ectopic pregnancies in 1979 to 1980 to about 32 per 100,000 during 1991 to 1999 [6], ectopic pregnancy remains the leading cause of maternal death in the first trimester. Most deaths occur due to rupture of the fallopian tube and massive hemorrhage. The cost of treating ectopic pregnancy is considerable, totaling approximately 1.1 billion US dollars in 1992 [7]. Based on a systematic review of the distribution of causes of maternal death worldwide, the World Health Organization found that reported deaths from ectopic pregnancy accounted for nearly 5% of maternal mortality in developed countries and less than 1% in developing countries [8]. Although ectopic pregnancy remains an important public health problem in developing countries where limited resources and poor access to care often lead to late diagnosis, the relative contribution of ectopic pregnancy to maternal mortality is low compared to hemorrhage, infection, hypertensive disorders, and unsafe abortion [8]. Because more than 60% of US women seek abortion care during the first 8 weeks of pregnancy [9], abortion providers have an opportunity to decrease morbidity from ectopic pregnancy by diagnosing and treating the condition early. This chapter assists this process by describing risk factors and diagnostic algorithms for ectopic pregnancy, as well as Management of Unintended and Abnormal Pregnancy, 1st edition. By M Paul, ES Lichtenberg, L Borgatta, DA Grimes, PG Stubblefield, MD Creinin c © 2009 Blackwell Publishing, ISBN: 9781405176965.