Pregnancy complication deaths drop, but not equally

Deaths from a dangerous pregnancy complication in which the embryo implants outside the womb have decreased in recent decades, according to a new study.

However, the authors found that the chance of dying from an ectopic pregnancy is almost seven times higher in black women than white women.

The overall decline is “a nice success story,” Dr. Kurt Barnhart, an obstetrician at the University of Pennsylvania School of Medicine in Philadelphia who was not involved in the study, told Reuters Health. “But we still have further recognition to go before we can really eliminate it as a problem.”

In an ectopic pregnancy, an embryo attaches and starts growing somewhere not in the uterus - usually inside one of the fallopian tubes. The embryo can’t survive and has to be removed with drugs or minor surgery, or it could rupture and put a mother’s life at risk.

About one or two of every 100 pregnancies in the U.S. are ectopic pregnancies, but most are caught when women have their first doctor’s visits early in pregnancy.

In the current study, researchers led by Dr. Andreea Creanga from the Centers for Disease Control and Prevention analyzed nation-wide records of all births and deaths between 1980 and 2007. Over that span, there were close to 900 deaths attributed to ectopic pregnancies, the authors calculated.

In the early 1980’s, one woman died of ectopic pregnancy complications for every 90,000 women that gave birth to a live baby. In the most recent few years, that declined to one death for every 200,000 live births.

Throughout the study, death from ectopic pregnancy was more likely in older women than in young women. In data from the end of the study period, women 35 years and older were 3 to 4 times more likely to die of complications related to an ectopic pregnancy than women younger than 25.

That wasn’t entirely unexpected, the authors said, because older women are more likely to have an ectopic pregnancy to begin with due to changes that occur in fallopian tubes as women age.

What was more striking was the difference between white women and black women - black women were almost 7 times as likely to die of an ectopic pregnancy compared to white women in recent years.

While it’s possible that black women are also naturally more likely to have this pregnancy complication, Barnhart said that the problem is probably one of access to health care.

Especially in inner cities, he said, minorities are less likely to see a doctor regularly and may have more trouble getting to a doctor’s office or hospital easily. If they do develop symptoms early in pregnancy, many black women will end up in the emergency room rather than seeing an obstetrician for help, Barnhart said - and in the ER, doctors may not connect the dots to an ectopic pregnancy.

The key to cutting down the risks of ectopic pregnancies is to catch them in the first 2 months - after that, the chances of severe complications go way up, Barnhart said.

So it makes sense that as ultrasound technology improves, the number of deaths from ectopic pregnancy complications would go down.

“Our capability of diagnosing this early and treating this early - this is probably behind the decline” in deaths, Creanga told Reuters Health.

Barnhart said that doctors have also gotten better at recognizing the early symptoms of an ectopic pregnancy, including bleeding and pain.

However, “there’s still unfortunately some people that ignore their signs, or their physicians don’t acknowledge them,” he said. “Sometimes people just don’t think it can happen to them.”

The most important message, Barnhart and Creanga agreed, is that women need to see a doctor as soon as possible if they have bleeding or unusual pain and they may be pregnant.

SOURCE: Obstetrics & Gynecology, April 2011.

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