USF public health leader involved in the FDOH investigation comments

Florida’s rate of ectopic pregnancy deaths jumped in 2009-10 – an increase that may be associated with delays in obtaining care and illicit drug use, according to a new report by the U.S. Centers for Disease Control and Prevention.  The state’s rise in ectopic pregnancy deaths, published in the CDC’s Feb. 17 issue of Morbidity & Mortality Weekly Report, runs counter to the national trend of steadily declining deaths.

“It was surprising,” said one of the report’s co-authors Dr. William Sappenfield, director of the Chiles Center for Healthy Mothers and Babies at USF, who was maternal-child health epidemiologist at the Florida Department of Health when the study was conducted.

“Nationwide, ectopic pregnancy death rates are going down, because the condition has become much easier and quicker to diagnose and treat,” said Dr. Sappenfield, chair of Community and Family Health at the USF College of Public Health.

Dr. William Sappenfield of the USF College of Public Health was a co-author
of the report published in the CDC’s Mortality & Morbidity Weekly.

Ectopic pregnancy occurs when an egg is fertilized outside the uterus, usually in the fallopian tube.  If it remains undetected the pregnant woman may die if the tube ruptures, leading to rapid blood loss.

Improvements in pregnancy testing, ultrasound examination and outpatient treatments, including laparoscopic surgery and medications, have contributed to the decline in deaths. This success is largely dependent on access to care so women with signs and symptoms of ectopic pregnancy can be identified and treated before tube rupture, shock and severe blood loss.

Dr. Sappenfield helped staff the multidisciplinary team investigating ectopic pregnancy deaths in Florida, based on a review of cause death, risk factors and prevention opportunities.

Florida’s ectopic pregnancy mortality ratio was similar to the national rate of 0.6 deaths per 100,000 live births during 1999–2008, but increased abruptly to 2.5 during 2009-2010.  This four-fold increase appeared to be linked in part to lack of access to care. The researchers found that the 13 women who died in the one year (2009-2010) were more likely to have collapsed from a hemorrhage before seeking care than the 11 women who died the previous decade from ectopic pregnancies. Of the eight women who collapsed during 2009-2010, six tested positive for illicit drug use.

“We clearly have not reached our potential to prevent this life-threatening condition,” Dr. Sappenfield said.

Based on their review, the investigators wrote: “Efforts to prevent ectopic pregnancy deaths need to ensure early access to care, promote awareness about early pregnancy testing and ectopic pregnancy risk, and raise public awareness about substance abuse risks, especially during pregnancy.”

While ectopic pregnancy cannot be prevented, Dr. Sappenfield said, pregnant women and those of childbearing age should not delay seeking medical attention for continuing abdominal or pelvic pain, usually 6 to 8 weeks after a missed period.  Better to quickly rule out an ectopic pregnancy than to risk future fertility and perhaps dangerous complications if the pregnancy ruptures the fallopian tube.

Story by Anne DeLotto Baier, USF Health Communications