The incidence of ectopic pregnancy in the United States has been increasing steadily during the past three decades from 4.5 per 1,000 pregnancies in 1970 to 19.7 per 1,000 pregnancies in 1992.1 This epidemic continues in other western countries; for example, Norway had an increase from 12.5 to 18.0 per 1,000 reported pregnancies during 1979 to 1993.2 Yet other countries, such as France and Sweden, are reporting a stabilization of the ectopic pregnancy rate.
In the United States, the prevalence of risk factors for ectopic pregnancy are increasing, accounting, in part, for the increased ectopic pregnancy incidence.1 Further, the increased incidence of ectopic pregnancy may be the result of earlier diagnosis, with the use of sensitive pregnancy tests and transvaginal ultrasound detecting some ectopic pregnancies that in the past may have resolved spontaneously before diagnosis.3
Despite the increased incidence, maternal deaths due to ectopic pregnancy are declining as a result of early diagnosis and therapy. Between 1979 and 1986, 13% of maternal deaths were secondary to ectopic pregnancy4; by 1992, this figure had decreased to 9%.1 Yet, ectopic pregnancies continue to be the leading cause of maternal death in the first trimester, 90% as a result of hemorrhage.4
Baylor College of Medicine, Houston, Texas
Correspondence: Margareta D. Pisarska, MD, Baylor College of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Smith Tower, Suite 801, 6550 Fannin, Houston, TX 77030.