Racial Disparities Found in Treatment of Tubal Pregnancies

Jaleesa Baulkman

October 21, 2021

Black and Latina women are more likely to have an open surgery compared with a minimally invasive procedure to treat ectopic pregnancy, according to research presented at the American Society for Reproductive Medicine's 2021 meeting.

The researchers found that Black and Latina women had 50% lesser odds of undergoing laparoscopic surgery, a minimally invasive procedure, compared to their White peers.

"We see these disparities in minority populations, [especially in] women with regard to so many other aspects of [gynecologic] surgery," study author Alexandra Huttler, MD, said in an interview. "The fact that these disparities exist [in the treatment of tubal pregnancies] was unfortunately not surprising to us."

Huttler and her team analyzed data from the American College of Surgeons' National Surgical Quality Improvement Program, which followed more than 9,000 patients who had undergone surgical management of a tubal ectopic pregnancy between 2010 and 2019. Of the group, 85% underwent laparoscopic surgery while 14% had open surgery, which requires a longer recovery time.

The proportion of cases performed laparoscopically increased from 81% in 2010 to 91% in 2019. However, a disproportionate number of Black and Latina women underwent open surgery to treat ectopic pregnancies during this time. Because they are more invasive, open surgeries are associated with longer operative times, hospital stays, and increased complications, Huttler said. They are typically associated with more pain and patients are more likely to be admitted to the hospital for postoperative care.

On the other hand, minimally invasive surgeries are associated with decreased operative time, "less recovery and less pain," Huttler explained.

The researchers also looked at trends of the related surgical procedure salpingectomy, which is surgical removal of one or both fallopian tubes versus salpingostomy, a surgical unblocking of the tube. Of the group, 91% underwent salpingectomy and 9% underwent salpingostomy.

Researchers found that Black and Latina women had 78% and 54% greater odds, respectively, of receiving a salpingectomy. However, the clinical significance of these findings are unclear because there are "many factors" that are patient and case specific, Huttler said.

The study is important and adds to a litany of studies that have shown that women of color do not receive optimal care, said Ruben Alvero, MD, who was not involved in the study.

"Women of color in general have seen compromises in their care at many levels in the system," Alvero, professor of obstetrics and gynecology at Stanford (Calif.) University, said in an interview. "We really have to do a massive overhaul of how we treat women of color so they get the same level of treatment that all other populations receive."

While the factors contributing to these health disparities can be complicated, Alvero said that one reason for this multivariate discrepancy could be that Black and Latina women tend to seek care at, or only have access to, underresourced hospitals.

Huttler said she hopes her findings prompt further discussion of these disparities.

"There really are disparities at all levels of care here and figuring out what the root of this is certainly requires further research," Huttler said.

The experts interviewed disclosed no conflicts on interests.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.


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