12. tbl. 99.árg. 2013

Incidence and management of ectopic pregnancy in Iceland 2000-2009

Nýgengi og meðferð utanlegsþykktar á Íslandi 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             %

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.

 

 





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