12. tbl. 99.árg. 2013
Incidence and management of ectopic pregnancy in Iceland 2000-2009
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 % |
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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 % |
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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.