An ‘epidemic’ of ectopic pregnancy in West Hertfordshire, UK?

Abstract

Our clinical impression is that the incidence of ectopic pregnancy in West Hertfordshire in the UK has been steadily rising to almost ‘epidemic’ proportions. On the basis of our clinical suspicion, a retrospective study was performed looking at the ectopic pregnancy rates in the region from 1993 to 2007. All histologically proven ectopic pregnancies were obtained using the hospital histology database and all deliveries (live births and stillbirths) were obtained using the Ciconia Maternity information System (CMiS). The numbers of legal terminations of pregnancy (NHS and non-NHS) as well as women of reproductive age were obtained using the databases from the Office for National Statistics and Department of Health. In terms of absolute numbers of histologically proven ectopic pregnancies, there were 38 cases in 1993, rising to a peak of 68 cases in 1998 and 59 cases in 2007. This equates to 6.5/1,000 deliveries in 1993, 11/1,000 deliveries in 1998 and 10.7/1,000 deliveries in 2007. Although there have been fluctuations in ectopic pregnancy rates over 15 years, this did not reach statistical significance. Therefore, contrary to our clinical suspicion, the incidence of ectopic pregnancy in West Hertfordshire has remained stable.

Keywords:

• Ectopic pregnancy
• epidemic
• incidence
• termination of pregnancy

Acknowledgements

We would like to thank Dr Sarah Hill (consultant histopathologist) and Mr David Budd for obtaining the histologically confirmed cases of ectopic pregnancy. Also we are indebted to Nora Lucey (consultant midwife) and Jacqui Mallard (clinical risk lead) who identified all deliveries over a 15-year period using our maternity database. We are grateful for the information supplied by the Office for National Statistics and Department of Health in determining the numbers of terminations of pregnancy as well as women of fertile age. Mike Streather from the Strategic Health Authority supplied information regarding geographical boundaries. Dr Elena Kulinskaya from Imperial College London provided statistical analysis of the data. Finally, our thanks to Mrs Julie Spendlove for her help in preparing this manuscript, which was in part funded by both the Watford Gynaecological Research Fund (WGRF) and the Ectopic Pregnancy Foundation (Registered charity no. 1122286).

Mr. Laurie Montgomery Irvine is the founder and honorary chief executive of The Ectopic Pregancy Foundation (EPF) which is a charity organisation set up by a group of National Health Service (NHS) doctors to help give advice about this distressing condition that affects up to 1 in 100 pregnancies. We provide advice for both the medical profession and the general public, in the form of the website which has 15 frequently asked questions available for download in over 25 languages (www.ectopicpregnancy.co.uk). There is also a 24-hour patient telephone helpline for advice.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.