Ectopic pregnancy and pelvic inflammatory disease: A renewed epidemic?

Objective: The incidence of ectopic pregnancy (EP) was reported to rise during the 1970s and 1980s; thereafter it remained stable or even declined. We studied whether changes in the incidence of pelvic inflammatory disease (PID) have had an impact on the incidence of EP and we hypothesise about the incidence of EP in the near future. Study design: EP and PID hospital admissions from 1980 to 2005 were derived from Dutch Medical Registries and incidence trends were calculated and analysed by joinpoint regression. Results: The peak incidence of EP in 1988 (11/1000 live births) was preceded by a peak incidence of admissions for PID in 1983 (0.6/1000 women of all ages). The EP rate declined towards 2005 (7.3/1000 live births) mainly due to a decrease in EP in urban regions and in older aged women (≥35 years). Presently, women <25 years and born between 1985 and 1990 are again at an increased risk of EP (12/1000 live births) but this rise was not preceded by a peak incidence of admissions for PID. Conclusion: On a population level, the peak incidence of EP in The Netherlands was preceded by a peak incidence of PID. A renewed rise in the incidence of EP is observed for young women. This may be related to the significant increase in positive tests for genital Chlamydia trachomatis during recent years.