This is the first study that has looked at how socioeconomic factors play into awareness about ectopic pregnancies. This was a very worthy topic to study - ectopic pregnancy is still the leading cause of maternal death in early pregnancy. Thus, all potentially pregnant women need to be able to recognize the seriousness of an ectopic pregnancy and how to access care.

The study authors sought to understand if women had differences in knowledge about ectopic pregnancies based on many factors, including ethnicity, income, and education. To determine this, they conducted a prospective, observational survey (questionnaire). Clinicians reviewed the 25 questions, then it was pre-tested in patients. 

Setting Up the Survey

The authors wanted to make sure that they reached a diverse target audience, so they conducted the study in East London, where 48% of the population has “a minority ethnic background.” This part of East London, Waltham Forest, is one of the most diverse areas of the UK.  The largest migrant groups in Waltham Forest are from Pakistan, followed by Poland and then Romania. 

In addition to diversity, they wanted sufficiency in their study. They calculated how many people live in Waltham Forest (around 270,000). Then, they divided the population in half to estimate the # of women living in Waltham Forest. Ultimately, they found that they needed 384 women to participate in the survey to ensure it represented the women of Waltham Forest. To be safe, they surveyed 400 women to account for questionnaires that weren’t completed fully. 

Inclusion Criteria: completing at least 75% of survey.

Exclusion Criteria: working in healthcare or in charity work involving ectopic pregnancy.

Statistics (for the uber curious)

“Two-tailed t-testing and analysis of variance (ANOVA) statistical methods were used for comparison of the data. The probability scores (p value) were therefore assigned to determine the statistical significance (statistical package – stata). As the sample size was (n ¼ 400), t-testing was chosen as the appropriate analysis, testing the difference between two sample groups. ANOVA was used when there were three or more variables in one research question. All of the significance values were calculated for two-sided 95% confidence intervals (CIs) and p value < .05.”

Results

The vast majority were of childbearing age - 83.5% of respondents were between the ages of 20-49 years. Ethnicity information is below.

Regarding the results of the questions they asked specifically about ectopic pregnancy: participating women knew more about ectopic pregnancy if they were white, single, had a higher income, and were college-educated. They also found that ethnic minorities compared to whites had a higher risk of losing a lot of blood with the ectopic pregnancy. Breaking it down even further, they found that black women were more likely than whites and Asian to lose over 1000 milliliters (mL) of blood.

Surprisingly, they found that having a previous ectopic pregnancy did NOT make a woman more likely to know important info about ectopic pregnancy; in fact, women who had miscarried knew more about ectopic pregnancy vs. women who had previously had an ectopic pregnancy.

Last but not least, they found that women had increased awareness about ectopic pregnancy if a celebrity had revealed having one (or had died from ectopic pregnancy).

Conclusions

Commendably, the authors ended their study with three calls to action.

1. Target information for patients in a way they will understand (put the information in the woman’s primary language).

2. Launch a series of local education meetings and groups that can women attend for further information.

3. Involve celebrities and the media to increase discussions around ectopic pregnancy.

We need to know what these inequalities look like in order to change them.

If you have thoughts about this, comments are ON!

Resources

Ectopic Pregnancy Patient Resources, per the American College of Obstetricians and Gynecologists—>click here

Hsu JY, Chen L, Gumer AR, et al. Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol. 2017;217(1):49.e1‐49.e10. doi:10.1016/j.ajog.2017.03.001

Jourdain, AR. Racial Disparities, Fragmentation of Care, and Adverse Outcomes Associated with Ectopic Pregnancy. Walden Dissertations and Doctoral Studies. 2019; 7673. https://scholarworks.waldenu.edu/dissertations/7673/. Accessed June 11, 2020.

McGurk L, Oliver R, Odejinmi F. Severe morbidity with ectopic pregnancy is associated with late presentation. J Obstet Gynaecol. 2019;39(5):670‐674. doi:10.1080/01443615.2018.1557610

Smart G, Tai A, Wong JC, Oliver R, Odejinmi F. Social prevalence of knowledge about ectopic pregnancy - tip of the 'health inequalities' iceberg? [published online ahead of print, 2020 Jun 9]. J Obstet Gynaecol. 2020;1‐6. doi:10.1080/01443615.2020.1741521