BACKGROUND AND PURPOSE:

• Mikhail et al. (Journal of Obstetrics and Gynaecology Research, 2018) describe the current trends surrounding ectopic pregnancy in the United states including:
  • Trends related to hospitalization
  • Patients’ characteristics
  • Surgical management

METHODS:

• Retrospective, cross-sectional study
• Participants: Patients treated for tubal ectopic pregnancy in an inpatient setting
• Age 18-50 years
• Data derived from the Nationwide Inpatient Sample databases
• Primary outcomes associated with tubal ectopic pregnancy in US from 1998-2011
  • Frequency | prevalence | changes in inpatient surgical management rates

RESULTS:

• There were 334,639 cases of ectopic pregnancies from among approximately 60 million maternal inpatient hospitalizations
• The rate of tubal ectopic pregnancies decreased from 77.2 in 1998 to 40.5 in 2011 (per 10,000 maternal admissions)
• The proportion of tubal ectopic pregnancies for which salpingostomy was performed decreased from 17.0% in 1998 to 7.0% in 2011
• Rate of salpingectomy increased from 69.3% in 1998 to 80.9% in 2011
• The temporal change in surgical choice was not related to differences in state IVF insurance mandates

CONCLUSION:

• The rate of tubal ectopic pregnancies managed in inpatient settings decreased from 1998 to 2011
  • Unclear if due to increased medical management or true decline
• The 82% rate of tubal ectopics found in this study was lower than the usual cited rate of 95% tubal out of all ectopic pregnancies
  • May be related to inpatient population used in this study
  • Non-tubal ectopics are more likely to be admitted
• Salpingostomies declined while salpingectomies increased
  • Authors suggests that data overall supports an equal likelihood of intrauterine pregnancy and subsequent fertility with a healthy contralateral tube
  • Risks associated with salpingotomy include retained trophoblast tissue and repeat ectopic pregnancy
  • Salpingectomy may be preferred approach in most cases of tubal ectopic pregnancy
  • Consider salpingotomy in cases where
    • Contralateral tubal disease is present
    • There are infertility factors
    • Patient is of advanced reproductive age

Learn More – Primary Sources:

National rates, trends and determinants of inpatient surgical management of tubal ectopic pregnancy in the United States, 1998-2011.

Related ObG Topics:

Diagnosing the Extrauterine Pregnancy-What You Need to Know

You’ve Diagnosed the Ectopic Pregnancy – When and How to Use the Medical Option

Disparities and the Management Patterns Over Time for Ectopic Pregnancy