JO(Xv THOUGHTS & OPINIONS Ectopic Pregnancy: A Nursing Approach to Excess Risk Among Minority Women Judith Bernstein, RNC, MSN Ectopic pregnancy rates have quadrupled during the last decade. Although maternal mortality has been reduced for white women, largely because of rapid pregnancy testing and improved ultrasonography, the death rate for minority women is almost twice that of white women, and minority adolescents are almost five times as likely to die of ectopic pregnancy. In this article, causative factors are identified, and the potential for race, gender, and age bias in diagnosis and treatment is discussed. Involvement by nurses in preventive programs, clinical research, and advocacy for policy change may help reduce ectopic pregnancy mortality rates. Accepted: June 1994 ctopic pregnancy is one of the leading causes of maternal mortality (Chow, Daling, Cates, & Greenberg, 1987). Although relatively few women face life-threatening consequences, ectopic pregnancy takes a toll: pain, anxiety, hospitalization, surgery, time away from work and home, loss of a desired pregnancy, and a future infertility rate of 20-70%, depending on how quickly the problem receives attention (Mitchell, McSwain, & Petersen, 1989). Since the Centers for Disease Control began moni- toring trends in ectopic pregnancy, the incidence per thousand reported pregnancies has risen fourfold, from 4.5 in 1970 to 16.8 in 1987. The rate per 10,000 women of reproductive age has quadrupled. In 1987 alone, 88,000 women were admitted to the hospital for ectopic preg- nancy, a 19%increase over the previous year (Centers for Disease Control, 1990). The annual economic burden for this diagnosis, including hospitalization and indirect costs, is estimated to be more than $177 million (Wash- ington, Arno, & Brooks, 1986). Several factors are responsible for this increase in ec- topic pregnancy, but the most significant is the preva- lence of sexually transmitted diseases (Barnes, Wenn- berg, & Barnes, 1983). Infection can cause scar tissue or adhesions to form in the fallopian tubes. Because of this blockage, fertilized eggs are unable to reach the normal site of implantation in the uterus, and they implant in- stead on the mucosal lining of the tube or elsewhere in the pelvis (Dubuisson, Aubriot, Cardone, & Vacher-La- venu, 1986). The incidence in the general population of chlamydia and gonorrhea, two infectious agents that cause most of this scarring, more than doubled from 1970 to 1987 (Gorwitz, Nakashima, & Moran, 1993; Webster, Greenspan, Nakashima, &Johnson, 1993). Despite the increase in ectopic pregnancy, maternal mortality from this condition has fallen from 63 per 10,000 in 1970 to 30 per 10,000 in 1987. Data from the Centers for Disease Control demonstrate (see Figure 1) that mortality rates have not kept pace with the climbing ectopic pregnancy rate, primarily because of the devel- opment of early pregnancy tests and vaginal ultrasound technology (Cacciatore, Stenman, & Ylostalo, 1989). Ec- topic pregnancy is increasing, but the number of deaths in the United States from this condition has declined. Although the decline in maternal mortality has been cited as an achievement (Damewood & Wallach, 19851, the problem of ectopic pregnancy is no success story. Treatment modalities have improved, but prevention measures are inadequate. Although the reported mortal- ity rate declined more than 90% from 1970 to 1986 ac- cording to death certificates, Stabile and Grudzinskas (1990) suggest that epidemiologic methods that use multiple sources of case finding show a maternal mortal- ity rate at least 10%higher than the rate indicated by vital statistics sources. The ectopic pregnancy death rate for African Americans and other minority groups remains al- most twice that of white women, and analysis by age group (see Figure 2) reveals a maternal mortality rate from ectopic pregnancy among minority adolescents that November/December 1995 JOCNN 803