Ectopic pregnancy surveillance, United States, 1970-1985

Ectopic pregnancy is now one of the leading causes of maternal death in the United States. In 1984 and 1985, both the numbers and rates of ectopic pregnancy increased. Since the rate of ectopic pregnancy remained unchanged for white women, the rate increase appears to be driven by the increasing rate among women of black and other races. Although ectopic pregnancies accounted for only 1.5% of the total pregnancies in 1984 and 1985, they accounted for 14% of the total maternal deaths in 1984 and for 11% of those deaths in 1985. However, the case-fatality rate for 1985 decreased to 4.2/10,000 ectopic pregnancies, down from the 35.5 deaths/10,000 ectopic pregnancies reported in 1970. Several factors may contribute to the increase in ectopic pregnancies, including heightened awareness of the condition, improved diagnostic technology, and possibly the higher prevalence of risk factors (e.g., acute and chronic salpingitis and sexually transmitted diseases) and the lower prevalence of protective factors (e.g., decreased use of oral contraceptives). Heightened awareness of the condition and improved technology may also be factors resulting in the decreased case-fatality rate.     

Copper T IUD use and ectopic pregnancy rates in the United States.

Over a four-year exposure period, the rate of ectopic pregnancy for women using a Copper T IUD was less than 1 per 1000 years of use. The cumulative 4-year probability of having an ectopic pregnancy while using the Copper T was 4 per 1000 women. These results are based on a study of 35,496 women with 38,064 years of use. Data on ectopic pregnancies in the United States provide a basis with which IUD experience may be compared. The National Hospital Discharge Survey shows a doubling in the number of ectopic pregnancies and in the incidence rates between 1965 and 1976. The relative risk of ectopic pregnancy among IUD users as compared with sexually active women not using the pill or sterilization may have been above 1 in 1965. In 1976, the relative risk is estimated to have been below 1. Compared with all woman-years of exposure, including women using contraceptive sterilization and the pill, the relative risk of extopic pregnancy to IUD users in 1976 was about 1. The IUD could not have been a major factor contributing to the recent doubling in the rate of ectopic pregnancy in the U.S.     

Contraceptive practice and ectopic pregnancy

The relationships between contraceptive practice and ectopic pregnancy were examined for users of barrier contraceptives, sterilization, steroidal contraceptives, and IUDs. Clinical studies on the outcome of pregnancy among diaphragm users indicated that they were not at any increased risk of ectopic pregnancy and may be at a reduced risk. Except for diaphragm users, there were insufficient published data to assess the risks of ectopic pregnancy for users of other barrier contraceptives. For all sterilization approaches, the International Fertility Research Program reported 6.9% ectopic pregnancies in over 20,000 voluntary sterilizations. Data provided by the United States Food and Drug Administration regarding rates of ectopic pregnancy for different types of IUDs suggested that copper-bearing IUDs were associated with a lower rate of ectopic pregnancy and that progesterone-releasing IUDs were associated with a higher rate than the non-medicated IUDs. No evidence as yet has demonstrated that IUDs cause ectopic pregnancy. Compared to women who use no contraceptive method, the use of IUDs greatly reduced the probability of intrauterine pregnancy but only somewhat reduced the probability of ectopic pregnancy. Recent data on the association between the duration of IUD use and the risk of ectopic pregnancy provided conflicting results. Women who have discontinued oral contraceptive or barrier contraceptive methods have not appeared to be at any increased risk of ectopic pregnancy.     

Pregnancy attitudes and contraceptive plans among women entering jail

Unplanned pregnancies are an important and costly public health problem. Women entering jail are at particularly high risk for unplanned pregnancies when they leave jail, given the high rates of poverty, substance abuse and sexually transmitted infections (STIs) in this population, all of which are associated with unplanned pregnancies. Attitudes toward pregnancy vary substantially, influencing openness of incarcerated women to starting a birth control method. This study was conducted as part of a Title X service evaluation and examined varying attitudes towards pregnancy and associated plans to use contraceptives. The current study included 223 women entering jail who were, under 36 years of age, fertile, sexually active with men, and not planning to become pregnant in the near future. Nearly half of the women had negative pregnancy attitudes (PAs), indicating that they did not want to become pregnant, while 41.3% endorsed ambivalent PAs. Compared to those with ambivalent PAs, those with Negative PAs were more likely to report a previous unplanned pregnancy (90.6% vs. 75.4%), a previous pregnancy termination (40.0% vs. 22.8%), and recent consistent use of contraceptives (37.0% vs. 21.7%). Women with negative PAs were significantly more likely to want to start or to continue a birth control method compared to those with ambivalent PAs (66% vs. 47%). Tailoring services to women's specific pregnancy attitudes during periods of incarceration may aid in preventing unplanned pregnancies in populations of high-risk women.     

异位妊娠发病相关因素及其与盆腔手术的相关性分析

目的：分析异位妊娠发病相关因素及其与盆腔手术的相关性。方法：随机选取80例异位妊娠与80例正常妊娠孕妇,分别为观察组与对照组,对两组进行问卷调查,对盆腔手术史、附件炎、盆腔炎、流产史、异位妊娠史、不孕史、子宫病变史以及宫内节育器放置等相关情况予以统计,比较与异位妊娠发生的相关性。结果：以上几项指标均与异位妊娠的发生具有相关性,盆腔手术是发生异位妊娠的高危因素。结论：明确发生异位妊娠的相关因素,并积极采取有效的预防措施,严格执行盆腔手术,利于降低异位妊娠发生率。     

Pregnancy Attitudes and Contraceptive Plans Among Women Entering Jail

ABSTRACT

Unplanned pregnancies are an important and costly public health problem. Women entering jail are at particularly high risk for unplanned pregnancies when they leave jail, given the high rates of poverty, substance abuse and sexually transmitted infections (STIs) in this population, all of which are associated with unplanned pregnancies. Attitudes toward pregnancy vary substantially, influencing openness of incarcerated women to starting a birth control method. This study was conducted as part of a Title X service evaluation and examined varying attitudes towards pregnancy and associated plans to use contraceptives. The current study included 223 women entering jail who were, under 36 years of age, fertile, sexually active with men, and not planning to become pregnant in the near future. Nearly half of the women had negative pregnancy attitudes (PAs), indicating that they did not want to become pregnant, while 41.3% endorsed ambivalent PAs. Compared to those with ambivalent PAs, those with Negative PAs were more likely to report a previous unplanned pregnancy (90.6% vs. 75.4%), a previous pregnancy termination (40.0% vs. 22.8%), and recent consistent use of contraceptives (37.0% vs. 21.7%). Women with negative PAs were significantly more likely to want to start or to continue a birth control method compared to those with ambivalent PAs (66% vs. 47%). Tailoring services to women's specific pregnancy attitudes during periods of incarceration may aid in preventing unplanned pregnancies in populations of high-risk women.     

Family planning, sexually transmitted diseases and contraceptive choice: a literature update--Part I.

Couples who use contraceptives not only protect themselves against unwanted pregnancies, but also may reduce their risk of becoming infected with a sexually transmitted disease (STD). No currently available method, however, is highly effective in protecting simultaneously against pregnancy and infection. Thus, couples who place high priority on minimizing both risks may have to use two methods. The need for contraceptive methods that provide effective protection against both pregnancy and STDs has been intensified by the HIV epidemic, but progress has been slowed by the lack of integration between the STD and family planning fields. The first part of this two-part article discusses the similarities and differences between the two fields, examines the impact of STDs on contraceptive use and services, and reviews the scientific literature dealing with the effects of condoms, spermicides and barrier-and-spermicide methods on the risk of STD transmission. Part II (which will appear in the next issue) examines what is known about the effects of oral contraceptives, the IUD, tubal sterilization and abortion on reproductive tract infections. The second part also includes a discussion of the trade-offs involved in choosing a contraceptive and presents estimates of the first-year rates of unplanned pregnancy and gonorrhea infection (given an infected partner) that would occur among women using various contraceptive methods.     

Trends in ectopic pregnancies and use of intrauterine devices in Lombardy, Italy 1979-1983

The frequency of ectopic pregnancies in Lombardy (a region in Northern Italy with a population of about 9 million inhabitants) over the period 1979-1983 was estimated using the Regional Hospital Discharge Registration System, where information is collected on all discharges from public and private hospitals. The ratio of ectopic pregnancies rose from 4.43/1000 pregnancies in 1979 to 4.93/1000 pregnancies in 1982 and flattened off in 1983 (4.78/1000 pregnancies). The frequency of ectopic pregnancies increased with maternal age from 2.30/1000 pregnancies in teenagers to 6.01/1000 pregnancies in women 30-39 years old, but remained constant thereafter (5.84/1000 pregnancies in women aged 40 or older). These trends were consistent with available information on intrauterine device (IUD) sales over the same calendar period. On the basis of a random subsample of the same dataset, we evaluated by means of a case-control approach, the relative risk of ectopic pregnancy in relation to IUD use. Current IUD users had an estimated age-adjusted relative risk of ectopic pregnancy of 3.6 (95% confidence interval = 1.4-8.0) in comparison with an hospital-based control group of non-pregnant women. In etio-pathological terms, the interpretation of this finding is not obvious since it is possible that IUD users are simply less protected than pill, barrier or other traditional method users against ectopic pregnancy. Nonetheless, on a public health scale, the impact of IUD on the incidence of ectopic pregnancy should be evaluated in relative terms of comparison with other methods and their utilisation in different populations.     

1606例高危妊娠产妇管理情况分析

目的为加强高危妊娠监护管理．提高产科质量,通过对高危孕妇产前检查资料的分析,为制定预防高危妊娠的措施提供资料。方法按照深圳市高危妊娠监护评分标准,收集2006年1月-2008年12月在罗湖区中医院、罗湖区妇幼保健院产科住院分娩的孕产妇围产期保健手册和高危妊娠监护结局评估表进行统计分析。结果1606例高危孕产妇中,前6位高危因素为年龄≥35岁、人流≥3次、产前出血、疤痕子宫、体重≥80kg和胎位不正。高危妊娠发生率为33．36％,单一高危因素占80．44％。结论应加强孕前保健意识,及时筛查高危并予以管理、监护和处理,使高危转为中危、低危,减少手术产,降低孕产妇及围产儿的死亡率．做好高危妊娠监护管理是提高产科质量,降低孕产妇、围产儿和新生儿死亡率的有效措施。     

Teenage pregnancy in the United States

One out of every 10 women aged 15-19 becomes pregnant each year in the United States. Of these pregnancies, five out of every six are unintended--92 percent of those conceived premaritally, and half of those conceived in marriage. The teenage pregnancy rate is high because only a minority (one in three) of sexually active young women always use contraceptives, and only one in two of these women rely on the most effective methods. The two most common reasons given by adolescents for not using contraceptives are believing that the risk of pregnancy is small, and failing to anticipate intercourse. Experience in other developed countries clearly shows that the incidence of adolescent pregnancy can be reduced if effective contraceptives are made widely available. Although high quality sex education programs that include information about contraception, reproductive biology and responsible sexual behavior can enhance the effectiveness of contraceptive delivery systems, they are not a substitute for the actual provision of services and supplies. However, there is formidable political opposition to the provision of such services by a vocal minority who believe that the crux of the problem is premarital sexual activity, and that lowering the cost of such behavior by reducing the risk of pregnancy will both legitimize adolescent sex and increase its prevalence. Consequently, there is a political impasse that guarantees a continuing large number of adolescent pregnancies. Further, even if contraceptives and sex education were readily available to all adolescents, there would still be a pool of teenagers who would see little benefit in postponing parenthood. This pool would be composed overwhelmingly of the poor and of blacks and Hispanics. Increasing the demand for pregnancy prevention among young women and men in this hard-core, high-risk group will be extremely hard to achieve without a fundamental restructuring of society.     

首次妊娠宫外孕调查及危险因素Logistic回归分析

目的了解广州市增城地区首次妊娠发生宫外孕的临床特征和危险因素,为临床预防干预和治疗提供决策依据。方法对首次妊娠宫外孕37例临床特征及危险因素进行回顾性研究,以同期首次正常宫内妊娠60例为对照研究,分析首次妊娠宫外孕的危险因素。结果首次妊娠宫外孕以停经史,下腹部不适和腹痛和不规则阴道流血为主要临床表现,宫外孕发生部位以输卵管壶腹部(51.4%)和伞部(21.6%)居多。肺结核及腹腔结核病史(OR=9.372,p<0.001),性病支原体感染(OR=3.566,p=0.006)是首次妊娠宫外孕的独立的危险因素。结论首次妊娠宫外孕和临床常见宫外孕的临床表现及发生部位类似。预防和及时治疗肺结核及结核性腹膜炎、预防及治疗性病支原体衣原体感染对防止首次妊娠宫外孕极为重要。     

The influence of secular effects and gravidity on the rate of ectopic pregnancy in a Norwegian population

In order to assess the influence of secular effects and gravidity on the incidence rate of ectopic pregnancy, information from reproductive history questionnaires was obtained for 7804 gravid females identified through the Norwegian Twin Panel. The overall ectopic pregnancy incidence rate was 5.6 per 1000 estimated conceptions, with rates increasing for women born after 1950. Women experiencing their first pregnancy were at lowest risk for that pregnancy being ectopic. When women were stratified by whether they were born before or after 1950, gravidity still had an effect on the incidence rate of ectopic pregnancy. Conversely, year of birth was influential when stratifying by gravidity. The results obtained here suggest that the recent increase in the incidence of ectopic pregnancy is unrelated to the number of prior pregnancies.     

Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic review

BackgroundUse of contraception lowers a woman's risk of experiencing an ectopic pregnancy. In the case of method failure, however, progestin-only contraceptives may be more likely to result in ectopic pregnancies than some other methods such as combined hormonal and barrier contraceptives.ObjectiveTo describe ectopic pregnancy risk associated with use of implants and progestin-only injectable contraceptives through a systematic review of published studies.Data SourcesWe searched electronic databases for articles in any language published through May 2015 describing studies of progestin-only injectables and implants. We also searched bibliographies and review articles for additional studies.Study Selection and ExtractionStudies that reported any pregnancies were included in the review. Independent data extraction was performed by two authors based on predefined data fields, and where possible, we calculated the proportion of pregnancies that were ectopic and the ectopic pregnancy incidence rate per 1000 woman–years.ResultsFifty-three studies of implants and 28 studies of injectables were identified; 79% reported pregnancy location. The proportion of ectopic pregnancy ranged from 0 to 100% with an incidence of 0–2.9 per 1000 woman–years in studies of marketed levonorgestrel implants. Studies of etonogestrel implants and the injectables, depot-medroxyprogesterone acetate and norethisterone enanthate, reported few ectopic pregnancies.ConclusionProgestin-only contraceptive implants and injectables protect against ectopic pregnancy by being highly effective in preventing pregnancy overall; however, the absolute risk of ectopic pregnancy varies by type of progestin. Risk of ectopic pregnancy should not be a deterrent for use or provision of these methods.     

Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection

BACKGROUND: Little is known about pregnancy rates among sex workers (SWs) or the factors that predispose SWs to this risk. We aimed to estimate the pregnancy incidence rate among Madagascar SWs participating in an intervention trial promoting use of male and female condoms and assess the influence of various predictive factors on pregnancy risk. METHODS: SWs from two study clinics in Madagascar participated in a randomized trial to assess the effect of peer education and clinic-based counseling on use of male and female condoms and prevalence of sexually transmitted infections (STIs). Women were seen every 2 months for up to 18 months; they received structured interviews at every visit, and physical exams at baseline and every 6 months thereafter. Site staff recorded information on pregnancies during interviews; pregnancy data were then merged with trial data for this analysis. RESULTS: Of 935 SWs in the analysis population, 250 became pregnant during follow-up. The cumulative probability of pregnancy was 0.149 at 6 months and 0.227 at 12 months. Comparable proportions of nonpregnant and pregnant SWs reported using highly effective contraception at baseline (approximately 16%); these users were younger and were more consistent condom users. Method switching and discontinuation were frequent. In multivariate analysis, nonuse of effective contraceptives and any self-reported unprotected sex were associated with higher incidence of pregnancy. Approximately 51% of women delivered, 13% reported a spontaneous abortion, 13% reported an induced abortion and 23% had missing pregnancy outcomes. CONCLUSIONS: Women traditionally targeted for STI/HIV preventive interventions need more comprehensive reproductive health services. In particular, SWs could benefit from targeted family planning counseling and services.     

Pelvic inflammatory disease

This article discusses the etiology, epidemiology, diagnosis, and treatment of pelvic inflammatory disease (PID). PID, which affects at least 1 million women in the US each year, has serious consequences: about 15% of cases become sterile after 1 infection, 15% develop chronic pain requiring surgery, and the ectopic pregnancy rate among women who do become pregnant is 10 times that among women without infection. The goal is to prevent PID by identifying cervicitis and endometritis before salpingitis develops and by advocating contraceptive methods that will reduce attack rates. Also important are prompt, accurate diagnosis and effective therapy. Sexually transmitted organisms are responsible for 50-75% of acute primary spontaneous salpingitis. Epidemiologic factors influence the rate of cervicitis and the development of salpingitis from cervicitis. These factors include age, number of sexual partners, frequency of sexual intercourse, and OC use. OC users have 1/2-1/4 the expected rate of both gonococcal and chlamydial salpingitis. The tremendous range of clinical signs and symptoms makes the diagnosis of salpingitis difficult, implying a need for physical and laboratory determinations. It is suggested that laparoscopy be more widely used to diagnose acute pain. Adequate treatment includes both antibiotic administration and close follow up to assess the clinical response and antibiotic compliance.     

Comparing the health risks and benefits of contraceptive choices

Simulation models were used to compare the health consequences of birth control methods currently relied on by American women with those of using no method. The incidence of morbidity and mortality related to unintended pregnancies, live births, abortions, upper genital tract infections, tubal infertility, cardiovascular disease and reproductive cancers were estimated for hypothetical cohorts of 100,000 women aged 15-44. Women who never use any method and who never have an abortion would have an average of 18 births during their reproductive lifetime, compared with no more than five among women using any of the available birth control methods. Consequently, use of any method prevents more deaths from pregnancy and childbirth than are associated with method use. The proportion of women who would become infertile--estimated by taking into account the likelihood of developing upper genital tract infections and the probability that any pregnancies that occurred would be ectopic--is reduced substantially if women at low risk of sexually transmitted diseases use any method and if women at high risk use oral contraceptives or barrier and spermicide methods. Oral contraceptive use has a relatively small, independent effect on the risk of cardiovascular diseases, but it greatly augments that risk in combination with smoking and increased age. When ovarian, endometrial and breast cancers are considered together, there will be approximately 110 fewer diagnoses of these three cancers per 100,000 ever-users of the pill aged 15-54 than among 100,000 never-users; furthermore, prior to age 45, 100,000 ever-users will experience 10 fewer deaths from ovarian or endometrial cancers than never-users of the pill.(ABSTRACT TRUNCATED AT 250 WORDS)     

2014—2018年妇科出院患者疾病构成分析

目的分析某院2014—2018年妇科出院患者疾病构成现状,为开展本地区妇科常见病的预防和医疗保健工作提供依据。方法对该院2014—2018年妇科出院患者进行回顾性分析。结果妇科出院患者中,位列前3位系统疾病依次是妊娠、分娩和产褥期(40.59%),泌尿生殖系统疾病(33.56%),肿瘤(16.63%)。妊娠、分娩和产褥期疾病前5种分别是异位妊娠、医疗性引产、稽留流产、先兆流产和自然流产;泌尿生殖系统疾病前5种分别是生殖道息肉、子宫其他非炎性疾患、子宫内膜异位、输卵管炎和卵巢炎;肿瘤前5位是子宫平滑肌瘤、卵巢良性肿瘤、宫颈原位癌、宫颈恶性肿瘤和子宫体恶性肿瘤。结论异位妊娠、医疗性引产、子宫平滑肌瘤、子宫息肉等为妇科常见病。基于常见疾病,应提高保健知识宣传和体检筛查力度,积极治疗早期疾病,降低妇科疾病发病率。     

Incidence of thyroid cancer in women in relation to reproductive and hormonal factors

Female residents of western Washington state aged 18-80 years in whom thyroid cancer was diagnosed between January 1974 and December 1979 were interviewed concerning their reproductive histories and their prior use of exogenous estrogens. Their responses were compared with those of a sample of women from the same population, individually matched to cases on telephone prefix. Use of each of several estrogen-containing preparations was associated with a small increased risk of thyroid cancer; parous women who had ever used a lactation suppressant had 1.7 times the risk of parous nonusers (95% confidence interval, 1.1-2.8); ever users of oral contraceptives had 1.6 times the risk of never users (95% confidence interval, 0.98-2.5); and ever users of postmenopausal estrogens had 1.4 times the risk of never users (95% confidence interval, 0.89-2.3). Among the low risk group of women, i.e., those who had never undergone radiation therapy and who had never had a goiter, a history of one or more pregnancies was also associated with a small increase in the risk of thyroid cancer (relative risk = 1.8, 95% confidence interval, 1.1-3.1). However, no increase in risk with increasing duration of use of oral contraceptives or menopausal estrogens or with increasing number of pregnancies was noted. While pregnancy and use of exogenous estrogens have an impact on the production of thyroid-stimulating hormone, their effect on the incidence of thyroid carcinoma, if present at all, appears to be small.     

Beyond contraception: the health benefits and risks of the pill

The use of oral contraceptives (OC) by an estimated 150 million women worldwide has prompted concern about their potential risks. But, there are also health conditions--medical and surgical disorders, reproductive tract cancers, and menstruation disorders--that oral contraceptives affect beneficially. OC users have a lower risk of iron deficiency anemia, an important consideration for nutritionally deficient women. The risk of developing pelvic inflammatory disease is also decreased in OC users, as is the risk of ectopic pregnancy. This is important for women in developing countries, where access to medical services for a life-threatening ectopic pregnancy might be limited. Using OCs lowers the incidence of surgery for benign breast disease, the incidence of retention cysts of the ovary, the risk of endometrial cancer, the risk of epithelial ovarian cancer, and relieves symptoms of dysmenorrhea and premenstrual syndrome. The risks associated with OC use, including stroke and heart attack, vary among age groups, smoking status, and other cardiovascular risk factors. For example, elevated serum cholesterol is lower among women in developing countries, so the associated risk of heart attack is lower for these women. Other complications associated with OC use are deep-vein thrombosis, pulmonary embolism, gallbladder disease, and hepatic adenoma. There is controversy about whether OC use increases the risk of cervical neoplasia. Studies that have attempted to define this risk are subject to methodological problems, in that increased surveillance of OC users results in a higher rate of detection. Some controversy exists about OC use and an increased risk of breast cancer, but no definitive results are available. Although the risks associated with OC use can be serious, these risks are only slightly higher among OC users compared with non-users. The benefits, such as reduced risk of serious diseases and gynecological disorders, seem to outweigh the risks, pointing to the need for accurate communication between health professionals and the women they advise about contraceptive choices.     

Induced abortion and the risk of subsequent ectopic pregnancy.

This study assessed the effect of legal induced abortion on ectopic pregnancy risk by using a comparison group of reproductive-age women who were at risk of becoming pregnant during the same time period the women with ectopic pregnancy conceived. Cases were members of Group Health Cooperative of Puget Sound who were hospitalized for ectopic pregnancy from October 1981 through September 1986 (N = 211). Controls were randomly selected members matched to cases on age and county of residence (N = 457). All subjects in this analysis had had one or more prior pregnancies. Eighty-eight cases (41.7 per cent) and 177 controls (38.7 per cent) had a history of one or more induced abortions. The relative risk of ectopic pregnancy associated with one abortion was 0.9 (95 per cent confidence interval 0.6, 1.3), adjusted for age, county, reference date, religion, gravidity, age at first pregnancy, lifetime number of sexual partners, and miscarriage history. Among women with two or more prior pregnancies, the risk associated with two or more abortions was 1.2 (0.6, 2.4). Controlling for pelvic inflammatory disease and use of intrauterine devices did not alter these risks. We conclude that legal abortion as performed in the US since 1970 has little or no influence on a woman's risk of ectopic pregnancy in subsequent pregnancies.