National trends in the management of tubal pregnancy, 1970-1987.

Tubal pregnancy leads to reduced childbearing potential and is a major cause of maternal morbidity and mortality in the United States. Several hospital-based studies have shown a trend toward more conservative management of tubal pregnancies, which reflects attempts to reduce morbidity and preserve fertility; however, the impact on future fertility remains unclear. To study national trends in the management of tubal pregnancy from 1970-1987, we analyzed data from the National Hospital Discharge Survey. Tubal pregnancies managed conservatively, using operative procedures that attempt to preserve the function of the involved fallopian tube, increased from approximately 2% in 1970-1978 to 12% in 1984-1987. During 1979-1987, conservative procedures were more than twice as common for women with private insurance as for those without it. The use of diagnostic laparoscopy increased from 10% of tubal pregnancies in 1970-1978 to 33% in 1979-1987, whereas the use of diagnostic laparotomy decreased from 24 to 2%.