Temporal Trends in Severe Morbidity and Mortality Associated with Ectopic Pregnancy Requiring Hospitalisation in Washington State, USA: a Population-based Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2019 Feb 21

PMID 30782901

Citations 4

Authors

Sarka Lisonkova

Justin Tan

Qi Wen

Lobna Abdellatif

Lindsay L Richter

Sukainah Alfaraj

Paul J Yong

Mohamed A Bedaiwy

Affiliations

Soon will be listed here.

Abstract

Objective: To examine temporal trend in maternal mortality/severe morbidity associated with hospitalisation due to ectopic pregnancy.

Design: A population-based observational study.

Setting And Participants: All 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.

Results: Hospitalisation 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).

Conclusions: Hospitalisation 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.

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References

Trabert B, Holt V, Yu O, Van Den Eeden S, Scholes D . Population-based ectopic pregnancy trends, 1993-2007. Am J Prev Med. 2011; 40(5):556-60. PMC: 3093105. DOI: 10.1016/j.amepre.2010.12.026. View

. Ectopic pregnancy--United States, 1990-1992. MMWR Morb Mortal Wkly Rep. 1995; 44(3):46-8. View

Bedaiwy M, Escobar P, Pinkerton J, Hurd W . Laparoendoscopic single-site salpingectomy in isthmic and ampullary ectopic pregnancy: preliminary report and technique. J Minim Invasive Gynecol. 2011; 18(2):230-3. DOI: 10.1016/j.jmig.2010.12.004. View

Lipscomb G, McCORD M, Stovall T, Huff G, Portera S, Ling F . Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999; 341(26):1974-8. DOI: 10.1056/NEJM199912233412604. View

Creanga A, Shapiro-Mendoza C, Bish C, Zane S, Berg C, Callaghan W . Trends in ectopic pregnancy mortality in the United States: 1980-2007. Obstet Gynecol. 2011; 117(4):837-843. DOI: 10.1097/AOG.0b013e3182113c10. View

Joseph K, Liu S, Rouleau J, Kirby R, Kramer M, Sauve R . Severe maternal morbidity in Canada, 2003 to 2007: surveillance using routine hospitalization data and ICD-10CA codes. J Obstet Gynaecol Can. 2010; 32(9):837-846. DOI: 10.1016/S1701-2163(16)34655-2. View

Washington A, Katz P . Ectopic pregnancy in the United States: economic consequences and payment source trends. Obstet Gynecol. 1993; 81(2):287-92. View

van Mello N, Mol F, Ankum W, Mol B, van der Veen F, Hajenius P . Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Fertil Steril. 2012; 98(5):1066-73. DOI: 10.1016/j.fertnstert.2012.09.040. View

Lydon-Rochelle M, Holt V, Nelson J, Cardenas V, Gardella C, Easterling T . Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records. Paediatr Perinat Epidemiol. 2005; 19(6):460-71. DOI: 10.1111/j.1365-3016.2005.00682.x. View

10.

Farren J, Jalmbrant M, Ameye L, Joash K, Mitchell-Jones N, Tapp S . Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. BMJ Open. 2016; 6(11):e011864. PMC: 5129128. DOI: 10.1136/bmjopen-2016-011864. View

11.

Stulberg D, Cain L, Dahlquist I, Lauderdale D . Ectopic pregnancy rates in the Medicaid population. Am J Obstet Gynecol. 2013; 208(4):274.e1-7. PMC: 3610838. DOI: 10.1016/j.ajog.2012.12.038. View

12.

Coste J, Bouyer J, Job-Spira N . [Epidemiology of ectopic pregnancy: incidence and risk factors]. Contracept Fertil Sex. 1996; 24(2):135-9. View

13.

Zane S, Kieke Jr B, Kendrick J, Bruce C . Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Matern Child Health J. 2003; 6(4):227-36. DOI: 10.1023/a:1021106032198. View

14.

Sowter M, Farquhar C . Ectopic pregnancy: an update. Curr Opin Obstet Gynecol. 2004; 16(4):289-93. DOI: 10.1097/01.gco.0000136494.49334.6b. View

15.

Sivalingam V, Duncan W, Kirk E, Shephard L, Horne A . Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011; 37(4):231-40. PMC: 3213855. DOI: 10.1136/jfprhc-2011-0073. View

16.

Stulberg D, Cain L, Dahlquist I, Lauderdale D . Ectopic pregnancy morbidity and mortality in low-income women, 2004-2008. Hum Reprod. 2016; 31(3):666-71. PMC: 4755444. DOI: 10.1093/humrep/dev332. View

17.

Hsu J, Chen L, Gumer A, Tergas A, Hou J, Burke W . Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol. 2017; 217(1):49.e1-49.e10. PMC: 5484775. DOI: 10.1016/j.ajog.2017.03.001. View

18.

Yao M, Tulandi T, KAPLOW M, Smith A . A comparison of methotrexate versus laparoscopic surgery for the treatment of ectopic pregnancy: a cost analysis. Hum Reprod. 1996; 11(12):2762-6. DOI: 10.1093/oxfordjournals.humrep.a019205. View

19.

Lydon-Rochelle M, Holt V, Cardenas V, Nelson J, Easterling T, Gardella C . The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Am J Obstet Gynecol. 2005; 193(1):125-34. DOI: 10.1016/j.ajog.2005.02.096. View

20.

Scholes D, Yu O, Raebel M, Trabert B, Holt V . Improving automated case finding for ectopic pregnancy using a classification algorithm. Hum Reprod. 2011; 26(11):3163-8. PMC: 3196880. DOI: 10.1093/humrep/der299. View