Introduction: Ectopic pregnancy can be life-threatening. Its treatment has changed radically during the last two decades. The study objective was to evaluate incidence and treatment of ectopic pregnancy in the Icelandic population during the decade 2000-2009.

Material and methods: Information was collected about all diagnosed cases, place and method of treatment and admissions. The annual incidence was calculated with reference to number of pregnancies (n/1000), number of women aged 15-44 years (n/10 000) and by 5-year age groups, comparing the periods 2000-2004 and 2005-2009.

Results: The number of ectopic pregnancies during these 10 years was 836, or 444 during the years 2000-2004 and 392 during 2005-2009. The average annual incidence was 15.6/1000 pregnancies and 12.9/10 000 women. There was an annual incidence reduction from 17.3 to 14.1/1000 pregnancies (p<0.01) and 14.1 to 11.7/10 000 women (p<0.01). Surgery was the primary treatment for 94.9% of women, methotrexate in 3.2% and expectant management in 1.9%. Surgical management decreased from 98.0% to 91.3% between 5-year periods as medical treatment increased (0.4% to 6.4%; p<0.0001). The proportion of laparoscopic procedures increased from 80.5% to 91.1% (p<0.0001). In the university referral hospital this changed from 91.3% to 98.1% (p<0.001) and in rural hospitals from 44.0% to 69.3% (p<0.001). Mean hospital stay after open surgery was 3.2 days, but 0.9 days after laparoscopy.

Conclusions: The incidence reduction of ectopic pregnancy is comparable to the development in neighbouring countries. Management has changed with increased use of laparoscopic surgery, medical and expectant treatment.

Key words: Ectopic pregnancy, incidence, surgical procedures, extrauterine, methotrexate.

Correspondence: Jens A. Guðmundsson, jens@landspitali.is

^{Baldvinsdottir A1, Gudmundsson JA1,2,Geirsson RT1,2}

¹University of Iceland, ²Landspítali University Hospital.

Tables and figures:

Table I. Number and incidence of ectopic pregnancies in Iceland 2000-2009. 

Year/Period	Number of ectopic pregnancies	Incidence (n/1000 pregnancies)	Incidence (n/10 000 women per year)
2000	95	17.8	14.9
2001	108	21.1	17.0
2002	78	15.7	12.4
2003	85	16.6	13.5
2004	78	15.1	12.4
2005	86	16.6	13.5
2006	65	12.2	9.7
2007	74	13.5	11.0
2008	88	15.1	13.0
2009	79	13.2	11.4
2000-2004	444	17.3	14.1
2005-2009	392	14.1	11.7
2000-2009	836	15.6	12.9

Table II. Management of ectopic pregnancy in Iceland 2000-2009.

	Total N = 836 n             %		2000-2004 N = 444 n            %		2005-2009 N = 392 n             %
Expectant management	16	1.9	7	1.6	9	2.3
MTX treatment	27	3.2	2	0.4	25	6.4
Unsuccessful MTX treatment	6	22.2
Surgery	793	94.9	435	98.0	358	91.3
Re-operations	21	2.7
MTX after surgery
Within 24 hrs	2	0.3
After more than 24 hrs	13	1.6

 

Table III. Surgical management of ectopic pregnancy in Iceland 2000-2009.

	Total N = 793 n             %		2000-2004 N = 435 n             %		2005-2009 N = 358 n             %
Laparotomy	47	5.9	32	7.3	15	4.2
Tube removed	42	89.4	29	90.6	13	86.7
Tube spared	5	10.6	3	9.4	2	13.3
Laparotomy, conversion from laparoscopy	70	8.8	53	12.2	17	4.7
Tube removed	49	70.0	37	69.8	12	70.6
Tube spared	21	30.0	16	39.2	5	29.4
Laparoscopy	676	85.3	350	80.5	326	91.1
Tube removed	480	71.0	239	68.3	241	73.9
Tube spared	196	29.0	111	31.7	85	26.1

 

Figure 1. Incidence of ectopic pregnancy (number/1000 pregnancies) in 5-years age groups in Iceland and comparison between the periods 2000-2004 og 2005-2009.

 

Figure 2. Incidence of ectopic pregnancy in Iceland 1985-2009.