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Doctors search for reasons for ectopic pregnancy spike

TAMPA — The number of Florida women who died because of a pregnancy complication has gone up sharply, sending medical researchers on a search for answers.

In 2009-10, 11 Florida women bled to death due to an ectopic pregnancy — compared with 13 such deaths for the entire previous decade.

Ectopic pregnancy — when a fertilized egg implants outside of the uterus —accounts for less than 2 percent of all pregnancies in the U.S., but causes nearly 4 percent of maternal deaths.

The rate of such deaths has been declining nationally, thanks to rapid pregnancy testing and ultrasound technology that allows these pregnancies to be detected and ended before they lead to a ruptured fallopian tube and death from blood loss.

But in Florida, deaths appear to be on the upswing, and surprised experts think drug abuse, lack of prenatal care and unfamiliarity with this condition are all likely factors

"We were not expecting mortality from ectopic pregnancy to go up," said Dr. William Sappenfield, director of the USF Chiles Center for Healthy Mothers and Babies, and co-author of the report released by the U.S. Centers for Disease Control and Prevention.

An average of 54 women a year die in Florida of pregnancy-related causes, and all the deaths are investigated by the state Department of Health.

Six of the 11 Florida women who died in 2009-10 of an ectopic pregnancy tested positive for illicit drug use, mostly cocaine. "We think (drugs) contributed substantially'' to those deaths, Sappenfield said.

Why? Drugs are connected with risky lifestyle choices in general, which can mean increased likelihood of sexually transmitted diseases that can damage the fallopian tubes.

Plus, woman ashamed of their addiction often avoid doctors even when they're in pain, said another study author, Dr. Robert Yelverton, a Tampa obstetrician-gynecologist and medical director of Women's Care Florida.

Lack of prenatal care, whether related to addiction or not, is another likely factor. Most of the women who died had no health insurance. Most hadn't told anyone they were pregnant — and may not have known themselves since this condition occurs early in pregnancy.

"There were women in the study brought to the hospital dying from blood loss. That was the first time they had seen a physician," Yelverton said.

Some of the women died at home. Some made it to a health care facility, but weren't treated in time to save them. One died in an ambulance.

Most of the women had symptoms for more than 12 hours before collapsing, going into shock and dying. Some, according to family members, were in pain for 24 to 48 hours.

Sappenfield and Yelverton said that if more people understood what ectopic pregnancy is, deaths might have been averted.

The first sign is usually light bleeding, followed by abdominal pain. "Any pain with bleeding is a sign that the pregnancy is threatening to rupture," Yelverton said.

Most symptoms and death from ectopic pregnancy occur between 8 and 14 weeks gestation. Some may mistake the pain for bad menstrual cramps or a stomach bug. Even health care workers might not suspect ectopic pregnancy.

"The key is recognizing what's going on, suspecting ectopic pregnancy and quickly seeing a health care provider," said Sappenfield. "Any woman of childbearing age who has been sexually active and develops moderate to severe belly pain, especially if she missed a menstrual period, needs to consult with a health care provider."

Contact Irene Maher at imaher@tampabay.com

Doctors search for reasons for ectopic pregnancy spike 02/22/12 [Last modified: Wednesday, February 22, 2012 10:48pm]

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