title: Sudden death: ectopic pregnancy mortality.
abstract: OBJECTIVE
  To describe the trends in ectopic pregnancy mortality in Michigan from 1985 through 1999 and compare to those of previous time periods.
  
  
  METHODS
  We reviewed all cases of maternal mortality from ectopic pregnancy in Michigan from 1985 through 1999. We extracted data from death certificates, hospital inpatient and emergency department records, medical examiner autopsy reports, and reviews by the Michigan Maternal Mortality Study. The Health Data Development Section of the Michigan Department of Community Health provided data on live births and maternal deaths
  
  
  RESULTS
  Of the 268 pregnancy-related deaths, 16 (6%) were caused by complications of ectopic pregnancy. Mean age at death was 27 (+/- 6) years. Thirteen deaths were to African-American women and 3 were to white women (P < .01). African-American women had an ectopic mortality ratio 18 times higher than white women (3.25/100,000 live births, compared with 0.18/100,000) Three cases of pregnancy-related death due to complications of ectopic pregnancy were considered preventable, and 2 others were of unknown preventability.
  
  
  CONCLUSIONS
  Ectopic pregnancy treatment has changed in the last 20 years coincident with a decrease in maternal mortality from ectopic pregnancy. Sudden death was the presenting scenario in 75% of nonpreventable ectopic deaths, an increase from previous analyses. A large racial disparity is apparent. Ideally, pregnancy care should start as soon as possible after the first missed menses; however, systemwide changes are needed to create a new norm promoting early access to pregnancy care and promoting education and testing to rule out pregnancy abnormalities.
  
  
  METHODS
  II-2
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive L4000 WH, Ann Arbor, MI 48109, USA. fwja@umich.edu
authors.forename: Frank W J
authors.initials: FW
authors.lastname: Anderson
authors.forename: Joanne G
authors.initials: JG
authors.lastname: Hogan
authors.forename: Rudi
authors.initials: R
authors.lastname: Ansbacher
mesh_terms: D000328:Adult; D044383:Black People; D003645:Death, Sudden / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008824:Michigan / Q000453:epidemiology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000208:ethnology / Q000401:mortality*; D044465:White People; D001741:Black or African American