Declining incidence of ectopic pregnancy in a UK city health district between 1990 and 1999

Human Reproduction, Oct 2001

BACKGROUND: On the basis of clinical impression that the number of cases of ectopic pregnancy seen in the City and Hackney Health District, London, was changing, a retrospective study of the years between 1990 and 1999 was carried out. METHODS: From the histopathology databases, cases of ectopic pregnancy and early pregnancy failure were identified. The number of deliveries at The Homerton Hospital was obtained from the Labour Ward register; the number of terminations of pregnancy and the number of fertile women was obtained from the Office for National Statistics, UK. RESULTS: There were 73 cases of ectopic pregnancy in 1990 rising to 96 in 1991 and then a fall to 52 cases in 1999. In terms of ectopic pregnancy per 100 deliveries, per all known pregnancies and per 1000 fertile women per year, there was a peak in 1991 and a fall to 1999. With regard to relative incidence per deliveries and per all known pregnancies, these falls were significant (P < 0.05). In 1991, there were 2.4 ectopic pregnancies per 100 deliveries, falling to 1.6 in 1999, a 33% fall. The reasons for this large decline are uncertain. CONCLUSIONS: There has been no change in patient population, diagnostic aids used or management protocols for patients with ectopic pregnancies.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://humrep.oxfordjournals.org/content/16/10/2230.full.pdf

Declining incidence of ectopic pregnancy in a UK city health district between 1990 and 1999

Human Reproduction Declining incidence of ectopic pregnancy in a UK city health district between 1990 and 1999 L.M.Irvine 1 M.E.Setchell 0 0 The Whittington Hospital , Highgate Hill, London N19 5NF , UK 1 Watford General Hospital , Vicarage Road, Watford, Herts WD18 0HB 3To whom correspondence should be addressed. BACKGROUND: On the basis of clinical impression that the number of cases of ectopic pregnancy seen in the City and Hackney Health District, London, was changing, a retrospective study of the years between 1990 and 1999 was carried out. METHODS: From the histopathology databases, cases of ectopic pregnancy and early pregnancy failure were identified. The number of deliveries at The Homerton Hospital was obtained from the Labour Ward register; the number of terminations of pregnancy and the number of fertile women was obtained from the Office for National Statistics, UK. RESULTS: There were 73 cases of ectopic pregnancy in 1990 rising to 96 in 1991 and then a fall to 52 cases in 1999. In terms of ectopic pregnancy per 100 deliveries, per all known pregnancies and per 1000 fertile women per year, there was a peak in 1991 and a fall to 1999. With regard to relative incidence per deliveries and per all known pregnancies, these falls were significant (P < 0.05). In 1991, there were 2.4 ectopic pregnancies per 100 deliveries, falling to 1.6 in 1999, a 33% fall. The reasons for this large decline are uncertain. CONCLUSIONS: There has been no change in patient population, diagnostic aids used or management protocols for patients with ectopic pregnancies. ectopic pregnancy/relative incidence changes - Ectopic pregnancy is defined as the implantation of a fertilized ovum outside the cavity of the uterus. It is of considerable medical importance since it is associated with an increased risk of maternal death (Stationery Office, 1998), sterility and problems in any subsequent pregnancies (Job-Spira et al., 1996). Ectopic pregnancy is also one of the main reasons for emergency admission to hospital, and investigations such as ultrasound scans, pregnancy tests and diagnostic laparoscopy have resource implications. Although no data are available from the UK, it has been estimated that in the USA in the 1980s the cost was about one billion dollars per year (Washington and Katz, 1993). The problem with epidemiological studies of extrauterine pregnancies is associated with its natural history which may be observed, or pass unrecognized, because of spontaneous resolution, and therefore not be observed. The result is that any calculation can be distorted by artefacts such as improved detection with the increasing use of laparoscopy, transvaginal ultrasonography, highly sensitive urine pregnancy test kits and quantitative serum human chorionic gonadotrophin assays (Brennan, 1997; Ankum, 2000). The choice of denominator used can also give rise to artefact. The three commonly used denominators are the number of births, the number of pregnancies and the number of women of reproductive age (i.e. 1544 years). Births provide the most accurate denominator as figures can usually be derived from public records, but pregnancies may be more correct since ectopics present at a time when the rates of miscarriage and elective pregnancy terminations are substantial and possibly should be included in any quoted figure. Since miscarriage is not a registerable event, these figures may be difficult to measure accurately. The earlier recognition of pregnancies with the availability of over-the-counter urine pregnancy test kits, and thus increased recognition of earlier pregnancy loss, will influence such comparisons of incidence (Cuckle and Murray, 1997). Figures based on the number of women of reproductive age are influenced by the fertility rates and contraceptive practices of the populations under scrutiny. In England and Wales national data have been published. Using official statistics on a routine 10% sample of hospital discharges (Beral, 1975), the incidence per 1000 registered pregnancies, excluding illegal abortions and miscarriages, increased throughout the study period from 3.2 per 1000 pregnancies in 1966 to 4.3 in 1972. This corresponds to a rate of 2.8 and 3.7 per 10 000 women aged 1544 years. There have been numerous publications on the increasing incidence of ectopic pregnancy since the late 1970s. In the UK, a doubling over the period from 1977 to 1986 has been reported (Dimitry and Morcos, 1990), and a similar increase has been reported in the Scottish Highlands (Kok et al., 1989). Many studies have tried to explain these rises, citing causes such as improvements in diagnosis, but also the possible association with the incidence of pelvic inflammatory disease (Stray-Pedersen 1996; Low et al., 1999; Kamwindo et al., 2000) or the change in maternal age distribution and the increased incidence of ectopic pregnancy in older women (Nyboe Andersen et al., 2000; Rajkhowa et al., 2000). There are, however, fewer papers r (...truncated)


This is a preview of a remote PDF: https://humrep.oxfordjournals.org/content/16/10/2230.full.pdf

L.M. Irvine, M.E. Setchell. Declining incidence of ectopic pregnancy in a UK city health district between 1990 and 1999, Human Reproduction, 2001, pp. 2230-2234, 16/10, DOI: 10.1093/humrep/16.10.2230