Increasing incidence of ectopic pregnancy: is it iatrogenic?

The incidence of ectopic pregnancy at the National Maternity hospital in 1996 was double that of the previous year. The rise in incidence coincided with the introduction at the hospital of both serum quantitative bHCG (beta human chorionic gonadotrophin) testing and a clear protocol for the early diagnosis of ectopic pregnancy. The aim of this study was to determine whether the increased incidence in 1996 was due to an increase in pre-existing risk factors for the development of ectopic pregnancy or to increased diagnosis of the condition. For the years 1986, 1995 and 1996, the incidence of ectopic pregnancy at the National Maternity Hospital was 1.8, 4.8 and 8.3 respectively per thousand pregnancies. There was no significant difference between the three years in terms of maternal age, parity or risks factors for ectopic pregnancy. The median gestational age at diagnosis decreased from 8 weeks gestation in 1995 to 6 weeks in 1996 (p < 0.001). However, the incidence of ruptured ectopic and blood transfusion was similar in both years. This study suggests that the two-fold increase noted in the incidence of ectopic pregnancy is related to earlier diagnosis of the condition. This is aided by the availability of serum quantitative bHCG testing. These findings have important implications for the management of women with ectopic pregnancy.