Maternal deaths from ectopic pregnancy in the South Atlantic region, 1960 through 1976

Abstract

The authors have calculated the maternal mortality rates from ectopic pregnancy in the Southeastern United States. Between 1960 and 1975 81 per cent of 207 ectopic deaths occurred in nonwhite women. A more detailed study of 24 deaths from ectopic pregnancy in North Carolina shows that from 1961 to 1976 4.2 per cent of all direct obstetric deaths and 15.9 per cent of deaths from hemorrhage were due to reptured ectopic gestation. The most striking observation was the dramatic reduction in deaths from ectopic pregnancy among nonwhite women. Maternal mortality rates for ectopic pregnancy should properly be based on the conception rate, consisting of live births plus abortions rather than live births alone. Missed diagnosis of ectopic pregnancy as a factor in maternal mortality rate requires more intensive educational efforts directed toward primary-care physicians.

PIP: Using statistics from the National Center for Health Statistics for the South Atlantic states for 1960-1975, maternal mortality rates from ectopic pregnancy were determined. The ectopic pregnancy death rate for the entire period was 0.29/10,000 live births, but the rate for blacks was markedly higher than the rate for whites. The rate decreased 40% from 1960-1965 to 1971-1975; however, when the rates were examined by race, it was found that the rate for whites had remained almost constant while the rate for blacks had decreased considerably. Apparently the decrease is related to improved living conditions and health care for blacks and not to any general improvement in the level of diagnosis and treatment of ectopic pregnancy. In a more detailed analysis of maternal death records from the North Carolina Medical Society for 1961-1976, the rate of ectopic pregnancy death was 6 times higher for blacks than for whites. The rate for all groups combined remained relatively constant, with a possible upward trend in the 1973-1976 period, and the proportion of direct obstetric deaths and of hemorrhage deaths accounted for by ectopic pregnancy deaths increased considerably from 1961-1964 to 1973-1976. An analysis of the 24 ectopic pregnancy deaths recorded in the North Carolina data, revealed that in 2/3 of the cases, the delay in diagnosis was attributable solely to physican delay. Both sets of data indicate a lack of progress in the early diagnosis of ectopic pregnancy and point to a need for doctors to be taught to "think ectopic." A recommendation is made that in the future maternal mortality rates for ectopic pregnancy be computed in reference to the number of conceptions instead of the number of live births as the recent increase in abortion tends to bias the computation. Tables for the South Atlantic states and for the District of Columbia show the rates for ectopic pregnancy deaths, number of live births, and number of ectopic pregnancy deaths by race and by state for 1960-1965, 1966-1970, 1971-1975, and the total for 1960-1975. A graph compares the ectopic pregnancy rates for whites and for blacks in each 5 year period for the South Atlantic Region. Graphs depicting the North Carolina data for the 1961-1964, 1965-1968, 1969-1972, and 1973-1976 show the rates for direct obstetric death, hemorrhage deaths, and ectopic pregnancy deaths as well as the % of these deaths attributable to ectopic pregnancy. Other tables for North Carolina show: 1) the age, race, and parity characteristics of ectopic pregnancy victims and 2) % of cases by symptoms, type of diagnostic confirmation, site of pregnancy, and by person responsible for diagnostic delay.