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Ectopic pregnancies on the increase.


There has been a steady increase in the number of ectopic pregnancies in the U.S. since 1970, says the Atlanta-based Centers for Disease Control (CDC)--an increase estimated to jump to dramatic proportions by 1990. An Indiana-based obstetrics and gynecology specialist says this is due to a number of factors, most notably loss of fertility.

Dr. Robert E. Rogers, professor of obstetrics and gynecology and chief of gynecology at the Indiana University Medical Center (IUMC) in Indianapolis, points to statistics compiled by the CDC on ectopic pregnancies since 1970, when the rate was 4.5 per 1000 pregnancies in this country. By 1980, that figure had risen to 10.5 per 1000--an increase of 133 percent from the decade before. Rogers expects that figure to be even higher, based in part on his experiences at IUMC with ectopic pregnancies. In 1978, the IUMC treated 24 cases of ectopic pregnancy; a decade later, that figure was estimated at 75.

Why the increases? Rogers points to the increase in sexually transmitted diseases--such as gonorrhea, chlamydia, and other bacterial infections--as one significant cause. Other factors, He says, include concern over side effects of the birth control pill, leading to its discontinuation and subsequent increases in both normal and extopic pregnancies, as well as increased sexual activity, particularly among teenagers. Finally, Rogers says, sterilization as a form of birth control might contribute to the rise in ectopic pregnancies, because ectopic pregnancies commonly occur whenever a woman becomes pregnant after her tubes have been tied.

"Loss of fertility is a major consequence of ectopic pregnancy," Rogers reports. "Fully one-half of all women who have had an ectopic pregnancy will never again be able to conceive. In addition, ectopic pregnancy is the leading cause of maternal mortality in the first trimester, responsible for approximately 10 percent of pregnancy-related deaths annually."

An ectopic pregnancy occurs whenever a woman's egg is fertilized outside the uterus. Most people acquaint ectopic pregnancies with tubal pregnancies because most ectopic pregnancies occur in the uterine tubes. Altogether, there are eight potential locations for ectopic pregnancies to occur, including the ovary, the cervix, and the two Fallopian tubes that transmit the egg or eggs from the ovary to the uterus. Early diagnosis is the key to management. Whenever a woman of any child-bearing age reports abdominal pain, excessive vaginal bleeding and/or an abnormal menstrual cycle (i.e., one or two simultaneously-missed menstrual periods, with no other symptoms of pregnancy), she should suspect a possible ectopic pregnancy. Ectopic pregnancies occur approximately once in every 300 pregnancies.

If the Fallopian tube has not ruptured, various procedures can be performed to simultaneously remove the growth and preserve the tube. And even though a ruptured tube usually must be removed, occasionally it can be saved, says Rogers, provided enough of the tube can be preserved before microsurgery is performed. Rogers adds that removal of the ovary is necessary after an ectopic pregnancy only in the event of damage or the presence of a blood-swelled tumor. (Medlink, Winter 1989, 2:1.)
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Publication:Medical Update
Date:Mar 1, 1989
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