Ectopic pregnancy and pelvic inflammatory disease: a renewed epidemic?

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Abstract

Objective

The incidence of ectopic pregnancy (EP) was reported to rise during the 1970s and 1980s; thereafter it remained stable or even declined. We studied whether changes in the incidence of pelvic inflammatory disease (PID) have had an impact on the incidence of EP and we hypothesise about the incidence of EP in the near future.

Study design

EP and PID hospital admissions from 1980 to 2005 were derived from Dutch Medical Registries and incidence trends were calculated and analysed by joinpoint regression.

Results

The peak incidence of EP in 1988 (11/1000 live births) was preceded by a peak incidence of admissions for PID in 1983 (0.6/1000 women of all ages). The EP rate declined towards 2005 (7.3/1000 live births) mainly due to a decrease in EP in urban regions and in older aged women (≥35 years). Presently, women <25 years and born between 1985 and 1990 are again at an increased risk of EP (12/1000 live births) but this rise was not preceded by a peak incidence of admissions for PID.

Conclusion

On a population level, the peak incidence of EP in The Netherlands was preceded by a peak incidence of PID. A renewed rise in the incidence of EP is observed for young women. This may be related to the significant increase in positive tests for genital Chlamydia trachomatis during recent years.

Introduction

In many countries a considerable rise in the incidence of ectopic pregnancy (EP) was reported during the 1970s and 1980s [1], [2], [3]. Since the late 1980s to the early 1990s, the incidence of EP no longer increased but remained stable [4], [5], [6] or even declined [7], [8], [9]. An important risk factor for EP is pelvic inflammatory disease (PID) [10]. Nowadays, genital Chlamydia trachomatis – frequently asymptomatic in women – has been identified as another major risk factor [10].

This paper explores whether changes in the incidence pattern of PID have had an impact on the incidence of EP in The Netherlands in a 25-year period. In addition, we investigated whether we can expect a trend change in the incidence of EP in The Netherlands in the near future due to changes in demography, life style or sexual behaviour.

Section snippets

Data sources

Hospital admissions of women diagnosed with EP and PID between 1980 and 2005 were identified from the Dutch National Medical Registration (Prismant, Institute for Healthcare Management, The Netherlands) by using the International Classification of Disease code (ICD-9) Clinical Modification Dutch extension (http://www.cdc.gov/nchs/icd9.htm). From 1992 onwards, this registry also contains data on date of admission, region and women's age.

The following ICD-9 CM codes were used to identify women

Results

The absolute numbers of hospital admissions for EP and PID were calculated for the period 1980–2005. A total of 45,799 hospital admissions for EP were registered. The absolute number rose from 1292 admissions in 1980 to a peak incidence of 2045 in 1988 and declined to 1375 in 2005. For PID, a total of 72,088 hospital admissions were registered. Like EP, after an initial rise in the incidence a decline was observed. The absolute number of PID rose from 3356 admissions in 1980 to a peak incidence

Conflict of interest

None.

Funding

This study is supported by grants of The Netherlands Organization for Health Research and Development (Agiko stipendium grant 920-03-328, Clinical fellow grant 40-00703-97-05-154). The sponsors had no involvement in the study.

Acknowledgement

We acknowledge the contribution of PRISMANT, Institute for Healthcare Management, Utrecht, The Netherlands.

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