Ectopic Pregnancy Mortality—Florida, 2009–2010

Abstract

Mortality rates for ectopic pregnancy in the United States decreased from 1.15 deaths per 100,000 live births during 1980–1984 to 0.50 during 2003–2007. This decline in the ectopic pregnancy mortality ratio has been attributed to improvements in diagnosis and treatment modalities, as well as increased access to early care of women with signs and symptoms of ectopic pregnancy. The present report discussed data showing a nearly 5-fold increase in the ectopic pregnancy mortality ratio in Florida between 1999–2008 and 2009–2010. The Florida Pregnancy-Associated Mortality Review subcommittee identified 13 ectopic pregnancy deaths that occurred in that state during the 10-year period from 1999 to 2008 and 11 during 2009–2010. This represented an increase in the mortality ratio from 0.6 deaths per 100,000 live births during 1999 to 2008 (which is similar to the national rate) to 2.5 during 2009 to 2010. Compared with 1999 to 2008, ectopic pregnancy deaths in Florida during 2009 to 2010 were more likely to have occurred in women who collapsed, presumably from hemorrhage associated with acute tubal rupture. Limited data based on information provided by household and family members and electronic medical records showed that most of these women received no health care before collapse. Six of the 8 women who collapsed during 2009 to 2010 tested positive at autopsy for use of illicit drugs. Therefore, the increased mortality appeared to be associated with delays in seeking health care and to illicit drug use among pregnant women. This report highlights the need for state-based pregnancy-related mortality surveillance to guide public health actions with the aim of preventing future deaths among women with ectopic pregnancy. Based on these findings, the Florida’s Florida Pregnancy-Associated Mortality Review committee recommends increased awareness among both pregnant women and health care providers about the importance of early access to care and the health risks associated with illicit drug use during pregnancy.