ectopic pregnancy

Mamas on Bedrest:Older & Black Women More Likely to Die From Ectopic Pregnancy.

March 28th, 2011

Older women and African American Women are more likely to experience and die from ectopic pregnancies than other groups of women.

The April 2011 issue of Obstetrics and Gynecology has published a retrospective study analyzing rates of ectopic pregnancy and deaths from ectopic pregnancy from 1980 to 1997. Researchers analyzed nation-wide records of all births and deaths between 1980 and 2007. The good news is that death rates from ectopic pregnancy dropped from 1/90,000 in the early 1980’s to 1/200,000 in 1997. The not so good news is that older women over age 35 had  a 3-4 fold increase of dying from ectopic pregnancy than a woman 25 or younger. Even worse, African American women of all ages are 7 times more likely to die from complications of an ectopic pregnancy than their white counterparts. The study was headed by Dr. Andreea Creanga from the Centers for Disease Control and Prevention.

The declines in deaths from ectopic pregnancies was not entirely a surprise. With improved prenatal care and advances in ultrasound technology, ectopic pregnancies are detected early and the complications (including deaths) are subsequently averted. Likewise, researchers were not surprised at the higher number of ectopic deaths in older women as there are physiologic changes in the fallopian tubes as a woman ages. But researchers were not at all prepared for the gaping difference in ectopic death rates between African American women and white women, and they have no concrete explanation for the disparity.

In a editorial published in Reuters,  Kurt Barnhart, MD, an obstetrician at the University of Pennsylvania School of Medicine in Philadelphia commented on the study and noted that many inner city women have difficulty accessing prenatal care and even when care is available, they often have difficulty getting to prenatal appointments. As many African American women are in this situation, they start prenatal care later than their white counterparts. “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.

Barnhardt and Creanga agree that this study must be one of many in evaluating death rates as a result of ectopic pregnancy. In the mean time, both suggest that women seek prenatal care as soon as possible after learning of a positive pregnancy, and that women know the signs and symptoms of an ectopic pregnancy and seek medical care immediately when symptoms are noted. Barnhardt and Creanga also encourage health care providers to have a low index of suspicion for ectopic pregnancy,  and to evaluate for ectopic pregnancy sooner rather than later when a woman complains of symptoms because of the risk of death if treatment is delayed.

Sources

Obstetrics & Gynecology: April 2011 – Volume 117 – Issue 4 – pp 837-843
doi: 10.1097/AOG.0b013e3182113c10
Reuters Health By Genevra Pittman, New York, March 25, 2011

Signs and Symptoms of an Ectopic Pregnancy

Early signs and symptoms may be the same as those of any pregnancy

  • a missed period
  • breast tenderness
  • nausea and fatigue

The first warning signs of an ectopic pregnancy often include

  • Light vaginal bleeding
  • Lower abdominal pain
  • Cramping on one side of the pelvis

If the fallopian tube ruptures, symptoms may include

  • Sharp, stabbing pain in the pelvis, abdomen, or even the shoulder and neck
  • Dizziness
  • Lightheadedness

Contact your obstetrics care provider or call 911 if you have

  • Severe abdominal pain
  • Heavy vaginal bleeding
  • Shoulder pain
  • A strong urge to defecate without results
  • Extreme lightheadedness, fainting or shock