Recent declining trend in ectopic pregnancy in France: evidence of two clinicoepidemiologic entities.

Objective: To assess the recent incidence of ectopic pregnancy (EP) in France (1992-1997) and to relate this incidence to trends in risk factors and use of contraception.
Design: Population register-based study.
Setting: Auvergne EP register (central France).
Patient(s): Women aged 15-44 years with EP in the Auvergne region.
Main Outcome Measure(s): Rates of EP, frequencies of exposure to risk factors, and sales of contraceptive methods in 1992-1997.
Result(s): The overall EP rate decreased 13.7%, from 96.4 per 100,000 women aged 15-44 in 1992 to 83.2 per 100,000 in 1997. The rate of EP associated with reproductive failure remained stable, but the rate of EP associated with contraceptive failure (mostly intrauterine device failure) decreased 26.6%. The trends in the prevalence of the main risk factors for EP and sales of contraceptive methods are concordant with the changes in EP rates: Risk factor prevalence did not change over time, but intrauterine device sales in the area declined in parallel.
Conclusion(s): The rates of EP as the result of contraceptive failure and as a result of reproductive failure evolve differently in the population and should not be confused in epidemiologic studies. This finding, along with published evidence that the two types of EP have different risk factors, location, prognosis, and perception by women, indicates that they are two distinct clinical entities possibly requiring different management.