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Obstetrics and gynaecology
Research
Temporal trends in severe morbidity and mortality associated with ectopic pregnancy requiring hospitalisation in Washington State, USA: a population-based study
  1. Sarka Lisonkova1,2,3,
  2. Justin Tan1,2,
  3. Qi Wen1,2,
  4. Lobna Abdellatif1,2,
  5. Lindsay L Richter1,2,
  6. Sukainah Alfaraj1,2,
  7. Paul J Yong1,2,
  8. Mohamed A Bedaiwy1,2
  1. 1 Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
  3. 3 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Sarka Lisonkova; slisonkova{at}cfri.ca

Abstract

Objective To examine temporal trend in maternal mortality/severe morbidity associated with hospitalisation due to ectopic pregnancy.

Design A population-based observational study.

Setting and participants All women hospitalised for ectopic pregnancy in Washington State, USA, 1987–2014 (n=20 418). The main composite outcome of severe morbidity/mortality included death, sepsis, need for transfusion, hysterectomy and systemic or organ failure, identified by diagnostic and procedure codes from hospitalisation files. Severe morbidity/mortality due to ectopic pregnancy were expressed as incidence ratios among women of reproductive age (15–64 years) and among women hospitalised for ectopic pregnancy. Comparisons were made between 1987–1991 (reference) and 2010–2014 using ratios of incidence ratios (RR) and ratio differences (RD). The Cochran-Armitage test for trend assessed statistical significance; logistic regression was used to obtain adjusted OR (AOR) and 95% CI, adjusted for demographic factors and comorbidity.

Results Hospitalisation for ectopic pregnancy declined from 0.89 to 0.16 per 1000 reproductive age women between 1987–1991 and 2010–2014 (p<0.001). Among reproductive age women, ectopic pregnancy mortality remained stable (0.03 per 100 000); and mortality/severe morbidity increased among women aged 25–34 years (p=0.022). Among women hospitalised for ectopic pregnancy, mortality increased from 0.29 to 1.65 per 1000 between 1987–1991 and 2010–2015 (p=0.06); severe morbidity/mortality increased from 3.85% to 19.63% (RR=5.10, 95% CI 4.36 to 5.98; RD=15.78 per 100 women, 95% CI 13.90 to 17.66; AOR for 1-year change was 1.08, 95% CI 1.07 to 1.08).

Conclusions Hospitalisation for ectopic pregnancy declined in Washington State, USA, between 1987 and 2014; however, mortality/severe morbidity associated with ectopic pregnancy increased in female population aged 25–34 years.

  • epidemiology
  • reproductive medicine
  • ectopic pregnancy

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-024353

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors SL designed the study, SL and QW performed data analysis and SL wrote the first draft of the manuscript. JT, LA, LLR, SA, PJY and MAB contributed to the interpretation of results and critically revised this first draft. All authors approved the final version of the manuscript.

    • Funding SL is supported by a Scholar Award from the Michael Smith Foundation for Health Research. This work was supported by the CIHR grant F17-02161.

    • Competing interests None declared.

    • Ethics approval All analyses were performed on publicly accessible de-identified data. An exemption from ethics approval was granted by the Department of Social and Health Services, State of Washington.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Analyses were based on administrative data collected and maintained by the Department of Health, State of Washington. The availability of the data is restricted. Permission for data access can granted after verification of the research goals by the Department of Social and Health Services, State of Washington.

    • Author note Hospitalization for ectopic pregnancy declined in Washington State, USA, between 1987 and 2014, while the cost and associated morbidity among hospitalised women increased.