Time trends in risk factors and clinical outcome of ectopic pregnancy.

Ectopic pregnancy (EP) admissions at The Johns Hopkins Hospital were reviewed for 160 patients admitted from 1970 to 1974 and 253 patients from 1980 to 1984. Over the decade, average annual admissions for EP increased by 64%, and a higher proportion of cases in 1980 to 1984 were unmarried women with no insurance coverage. There were significant increases in cases with a history of sexually transmitted diseases (from 19.1% to 31.6%) and in recurrent EPs (7.6% to 19.0%) but declines in EP associated with contraceptive failures. Newer diagnostic techniques such as quantitative serum human chorionic gonadotropin assays, pelvic ultrasound, and laparoscopy were more frequently used in the 1980 to 1984 period, resulting in less severe morbidity on admission, more conservative surgical management, and reduced length of hospitalization. Thus, although admissions for EP have increased, the severity of illness has been reduced by earlier diagnosis and more conservative management.