Ectopic pregnancy was first described in the 11th century, and, until the middle of the18th century, it was usually fatal. John Bard reported the first successful surgicalintervention to treat an ectopic pregnancy in New York City in 1759.The survival rate in the early 19th century was dismal. One report demonstrated only 5 patients of 30 surviving the abdominal operation. Interestingly, the survival rate in patients who were left untreated was 1 of 3.In the beginning of the 20th century, great improvements in anesthesia, antibiotics, and blood transfusion contributed to the decrease in the maternal mortality rate. In the earlyhalf of the 20th century, 200-400 deaths per 10,000 cases were attributed to ectopic pregnancy. In 1970, theCenters for Disease Control and Prevention (CDC)began torecord the statistics regarding ectopic pregnancy, reporting 17,800 cases. By 1992, thenumber of ectopic pregnancies had increased to 108,800. Concurrently, however, thecase-fatality rate decreased from 35.5 deaths per 10,000 cases in 1970 to 2.6 per 10,000cases in 1992.
Ectopic pregnancy is derived from the Greek word
meaning out of place, and itrefers to the implantation of a fertilized egg in a location outside of the uterine cavity,including the fallopian tubes, cervix, ovary, cornual region of the uterus, and theabdominal cavity. This abnormally implanted gestation grows and draws its blood supplyfrom the site of abnormal implantation. As the gestation enlarges, it creates the potentialfor organ rupture because only the uterine cavity is designed to expand and accommodatefetal development. Ectopic pregnancy can lead to massive hemorrhage, infertility, or death.
Since 1970, the frequency of ectopic pregnancy has increased 6-fold, and it now occurs in2% of all pregnancies. An estimated 108,800 ectopic pregnancies in 1992 resulted in58,200 hospitalizations with an estimated cost of $1.1 billion.
Multiple factors contribute to the relative risk of ectopic pregnancy. In theory, anythingthat hampers the migration of the embryo to the endometrial cavity could predisposewomen to ectopic gestation. The most logical explanation for the increasing frequency of ectopic pregnancy is previous pelvic infection; however, most patients presenting with anectopic pregnancy have no identifiable risk factor. The following risk factors have beenlinked with ectopic pregnancy:
Pelvic inflammatory disease