Treatment for ectopic pregnancies, or pregnancies in which fertilization occurs in places other than the womb, such as in the fallopian tubes, cervix and even ovaries, is the topic of a new study by Dr. Catherine Sewell and Dr. Jean Anderson of Hopkins.
While pregnancy remains one of the most difficult procedures for women to experience, ectopic pregnancy offers yet another potential obstacle. Ectopic pregnancy remains a common condition and can lead to life-threatening bleeding and loss of fertility.
The backdrop for this new study was data from 1992, which reported that ectopic pregnancy in the United States occurred in around 0.182 percent of pregnancies, or in about 18 out of 10,000. Furthermore, treatment for ectopic pregnancies from 1994-1999 was typically an extirpative operation, or one in which an incision is made into the abdominal wall to remove the ectopic pregnancy.
According to the data, 81.9 percent of cases were treated extirpatively rather than with some other minimally invasive procedure. The purpose of Dr. Sewell and Dr. Anderson's study was to see whether treatment had changed since 1999.
By combining data from the Maryland Health Service Cost Review Commission (HSCRC), the discharge database which collects medical records from 94 percent of the hospitals in Md., with the census data from the Maryland State Data Center, the researchers were able to compile a nearly complete overview of births in Md., allowing them to analyze pregnancy types, treatments and outcomes for their study.
In analyzing the data, Sewell and Anderson found that a total of 2,027 patients underwent surgical procedures for ectopic pregnancies, or about five in 10,000 women, which indicated a fall from the 1992 numbers. From these numbers, treatment was broken down into conservative procedures where regions of ectopic pregnancy were treated and extirpative procedures where the entire region of ectopic pregnancy was removed. According to the data, extirpative procedures still dominated 88.01 percent to 11.99 percent over conservative procedures. This statistic actually illustrated a 6.11 percent increase in invasive surgery compared to the previous study from 1994-1999.
In investigating the causes for this spike in extirpative versus minimally invasive procedures, Sewell and Anderson offer that perhaps the ectopic pregnancies admitted to the hospital are the more severe cases. When these patients reach the operating room, the damage can be extensive and require invasive surgery.
In light of their findings, the researchers believe that ectopic pregnancies must be treated earlier, allowing patients to avoid such invasive procedures in later stages. Interestingly, in 2001 an algorithm was devised to evaluate women with suspected ectopic pregnancies, which, if used today, could help in the treatment of this condition.
Furthermore, more detailed analyses of pregnant women suggested by Sewell and Anderson, such as a five-level triage system, would offer more streamlined and coordinated interactions among medical staff members.
The data from the study illustrates a need to monitor ectopic pregnancies more closely and develop systems to better manage and evaluate pregnant women in Md.
