Ectopic pregnancy deaths have nearly doubled. It’s worse in states with abortion bans

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This story was originally published by ProPublica , a nonprofit newsroom that investigates abuses of power. Sign up to receive its biggest stories as soon as they’re published.

The number of women who died after an ectopic pregnancy has spiked in recent years, a ProPublica analysis found. The mounting deaths in Centers for Disease Control and Prevention data have drawn little scrutiny or response.

Such deaths typically occur in the first trimester, after a pregnancy fails to properly implant in the uterus and begins to develop elsewhere, most commonly inside a fallopian tube. The embryo grows until it causes the organ to rupture, triggering catastrophic bleeding.

With prompt and appropriate medical care, maternal health experts say, women should not die. Yet ProPublica’s analysis found a stark and baffling increase: Almost 200 women with the condition died from 2020 to 2025, compared with about 100 in the previous six years.

“A death related to ectopic pregnancy should really be a never event,” said Dr. Alice Abernathy, an OB-GYN in Philadelphia.

While chaos and access issues at hospitals during the COVID-19 pandemic likely contributed to at least some of the deaths, the surge has persisted, raising serious questions about the role of the most significant disruption to maternal healthcare in the years since: state restrictions on abortion.

To treat an ectopic pregnancy, which is almost never viable, doctors must terminate it. But lawsuits and federal complaints have alleged that some medical providers are hesitating or flat-out refusing to do that in states where they face criminal penalties for performing an abortion. Patients described their terror.

“I genuinely thought I was going to die,” said Kyleigh Thurman, whose right fallopian tube ruptured after she struggled to get ectopic care in Texas in 2023.

“There were a few times I asked my husband if I was going to die,” Leitaea Lowrimore of Oklahoma said in a lawsuit after being denied treatment for an ectopic pregnancy at multiple hospitals in February. “I kept thinking about our kids.”

To determine whether these issues go beyond anecdotes, ProPublica analyzed the data collected from every state by the CDC to look for patterns. The analysis shows a growing divide for women in states with strict abortion bans compared with those without.

While the uptick in ectopic deaths occurred nationwide, the climb has been much steeper in states that banned abortion after the Supreme Court overturned Roe v. Wade in 2022.

ProPublica shared its analysis with more than a dozen maternal health experts, including leaders in the field, who were unaware of the spike; early pregnancy complications are chronically underresearched.

While they cautioned that abortion bans alone can’t explain the national rise, maternal health experts said any examination of the spike should include the documented delays in care caused by the laws, including for ectopic pregnancies.

In Thurman’s case, despite clear signs of an ectopic pregnancy, two emergency departments sent her home without resolving the complication. Regulators in 2025 found that one of the hospitals, Ascension Seton Williamson, failed to properly screen Thurman for a suspected ectopic pregnancy and did not call in an OB-GYN, in violation of the hospital’s own policies and federal law that requires emergency departments to treat and stabilize patients before discharging them. Thurman has an ongoing lawsuit against Ascension Seton Williamson and the other hospital, Ascension Seton Highland Lakes, for medical malpractice.

Thurman had to have her fallopian tube removed after it ruptured. (Thurman is not related to Amber Thurman , who died in Georgia, which also has an abortion ban, after doctors delayed treating different pregnancy complications in 2022.)

“I’ve never been in a situation where I didn’t get healthcare when I needed it,” Thurman told ProPublica, comparing the condition to having “a time bomb you can’t control.”

A spokesperson for the Ascension Seton hospitals said in a statement, “When a patient experiences a serious or life-threatening condition during pregnancy, our clinicians provide medically indicated treatment, including treatment for an ectopic pregnancy.” The hospital has denied Thurman’s malpractice allegations in a court filing .

Ectopic pregnancies, while rare, have long been recognized as the leading cause of maternal deaths in the first trimester. The condition impacts up to 2% of pregnancies in the U.S. Because government agencies don’t require hospitals to track or report overall ectopic diagnoses, it is impossible to know whether the condition itself is becoming more common.

While rates for other pregnancy-related deaths also increased during the pandemic, those climbs have largely subsided.

Experts aren’t sure why ectopic deaths have continued to rise. Ectopic pregnancies are more common among older women, but the increase in deaths has been even more stark among younger women, the analysis showed.

Aliaksei Smalenski/Adobe Stock

Abortion laws impact people trying to become pregnant, too

Anti-abortion groups have suggested that the use of abortion pills prescribed online is leading to more undiagnosed ectopics because telehealth patients don’t receive an ultrasound. But studies have found that ectopic rates are far lower among people who seek medication abortions than in the general population. Telehealth clinics ask questions that filter out patients at higher risk of ectopic pregnancy and follow up with those they treat to screen for symptoms, said Ushma Upadhyay, a researcher at the University of California, San Francisco, who studies telehealth abortion administration.

Experts told ProPublica that more research is required to determine the role of the abortion bans in the rise of ectopic-related deaths. Many states with bans, which generally provide less Medicaid funding and coverage to low-income women, have long had poorer maternal outcomes. “It’s a real challenge to try and tease out one thing out of the array of factors that undermine women’s health in these states,” said Eugene Declercq, a public health researcher at Boston University.

But experts said ProPublica’s data analysis, along with stories about delays in ectopic care, underscores the need to find out what is driving the deaths.

“Reproductive health is unusual across medicine when we consider how swiftly policy changes affect the care patients can receive,” said Dr. Courtney Schreiber, a professor of obstetrics and gynecology.

Caitlin Myers, an economist at Dartmouth College who studies abortion policy, said the deaths should be investigated: “This is a potentially profound consequence of the regulation,” she said.

Many state abortion bans include exceptions for ectopic pregnancies. But experts have worried that doctors are hesitating to offer treatment without an ironclad diagnosis, which clinicians say can take time and increase risks to the mother.

Ectopic pregnancy symptoms often begin with abdominal pain and bleeding, which send women to emergency rooms. There, doctors use ultrasounds to locate where the pregnancy has implanted.

However, embryos are often not visible on an ultrasound early in pregnancy. That could mean the pregnancy is ectopic, but it may also be a miscarriage or normal pregnancy that’s too small to see. Doctors can also assess whether the pregnancy is likely ectopic through blood tests over multiple days.

If the pregnancy is ectopic, the risk of rupture increases the longer treatment is delayed. In a state without a ban, a patient could decide at any point that that risk is not worth taking and opt to terminate the pregnancy.

In a state with a ban, however, that option may not exist. If doctors can confirm the pregnancy is ectopic through an ultrasound, they can protect themselves from having their decision to terminate questioned, perhaps by a zealous prosecutor. But waiting for this can delay treatment by days or even weeks.

Kathleen Flynn for ProPublica

She faced a life-threatening miscarriage. Under Arkansas’ abortion ban, even calls to the governor’s office didn’t help

“Seeing a mass is not the only reason to have high suspicion for an ectopic pregnancy,” said Dr. Rebecca Nerenberg, an emergency medicine doctor in New York and the clinical director at Access Bridge, which educates ER doctors on reproductive healthcare and has released evidence-based guidelines for diagnosing possible ectopic pregnancies.

Experts say that doctors should be able to offer treatment when other symptoms are present, such as plateauing pregnancy hormone levels, bleeding and abdominal pain. Patients can be treated with a procedure or a cancer drug that stops cells from growing.

But for women in states with abortion bans, getting that treatment can be difficult.

Lowrimore, who lives near the state border in Oklahoma, sought care at an Arkansas emergency department in February after experiencing abdominal pain and significant bleeding. She was sent home and told to return for more tests after being diagnosed with a “pregnancy of unknown location,” because an ultrasound could not show where her pregnancy had implanted, according to a lawsuit.

Lowrimore visited three different hospitals across both states over the following week as she began passing blood clots and the pain intensified, radiating up the left side of her body, according to the lawsuit.

The fact that the states’ abortion bans make exceptions for ectopic pregnancies did not help her, even though doctors acknowledged that was a possible diagnosis. In each visit, they didn’t treat her for that condition. One told her that intervening in her pregnancy could land him jail time — “10 years in the poky,” according to the suit. “I felt like my life was a risk he couldn’t afford,” she said in the lawsuit filing.

After consulting a lawyer, Lowrimore finally drove to a hospital in Kansas, where abortion is legal, and got an injection of the cancer drug called methotrexate within hours of arrival.

Lowrimore’s lawsuit, in which an OB-GYN and six women who were denied care are seeking to block the Arkansas abortion ban , is ongoing. Lowrimore also filed complaints under the same emergency medicine law as Thurman against the three hospitals. Regulators cited Mercy Hospital in Fort Smith, Arkansas, for failing to provide care during the eight hours Lowrimore waited to be seen. The other two hospitals were not found to have violated that law, and they did not respond to requests for comment.

A spokesperson for Mercy Hospital declined to comment on the case, saying that, “in tragic situations when a mother suffers from an urgent, life-threatening condition during pregnancy, Mercy provides all medically indicated treatment to save her life.”

Many experts predicted that ordeals like the ones Lowrimore and Thurman described would occur when abortion bans took effect. To see if more women with ectopic pregnancies are experiencing severe health outcomes, ProPublica analyzed hospital data from Texas, the most populous state to ban abortion.

In this new analysis, ProPublica found that 310 more patients in Texas experienced substantial blood loss after an ectopic pregnancy in 2023 and 2024 compared with 2018 and 2019, an increase of about 29%. Similar to ectopic deaths, the rise appeared to begin during the COVID pandemic, but the rate of complications remained elevated after hospital systems stabilized and the state passed its restrictive law. ProPublica is working to acquire similar data from states without abortion bans.

In response to ProPublica’s reporting on the deadly impacts of Texas’ abortion ban , the state passed the Life of the Mother Act in 2025, which attempted to clarify what kinds of abortions are allowed by the state’s law, explicitly adding ectopic pregnancies to the list.

But new guidance from the Texas Medical Board includes only a case study with an ectopic pregnancy that can be seen in an ultrasound, remaining silent on the difficulty of early ultrasounds to detect where a pregnancy has implanted. This leaves open the possibility that a prosecutor could question whether such a case was really ectopic, in a state where doctors face up to 99 years in prison for performing illegal abortions.

Lexi Parra for ProPublica

‘Ticking time bomb’: A pregnant mother kept getting sicker. She died after she couldn’t get an abortion in Texas

A spokesperson for the Texas Medical Board said the course is not intended to cover all scenarios and that it “explains that imminent harm is unnecessary and specifically states that physicians who follow evidence-based medicine, standard emergency protocols, and proper documentation face minimal risk.” Asked whether a conclusive ultrasound image is necessary for an ectopic diagnosis, the spokesperson said, “The Board has consistently stated that providing commentary on every possible situation would be impractical.”

But Michelle Maloney, an attorney who represents Thurman and 13 other Texas women or their families who say they were denied care — including seven with ectopic pregnancies — said she still gets frequent calls from women who say they were denied care for pregnancy complications. “I don’t think specific exemptions address the massive gray areas that arise in pregnancy,” she said.

Solutions are unlikely to come from the states themselves. A previous ProPublica investigation found that states with strict bans are not studying whether their laws are contributing to maternal deaths. And others have not followed Texas in attempting to amend their bans.

One of the biggest challenges to reducing ectopic pregnancy deaths nationwide is the lack of awareness, research and data.

No one, for example, is tracking whether women who experienced ectopic pregnancies also had one or more common risk factors, like a history of ectopic pregnancies, infertility or use of hormonal intrauterine devices, according to ProPublica’s review of maternal health statistics and interviews with experts.

Nor has any published research addressed the connection between recent ectopic pregnancy death rates and untreated infections like gonorrhea and chlamydia, which increased substantially during the first years of the pandemic before declining again. Those infections can cause pelvic inflammatory disease, which causes fallopian tube scarring and raises the long-term risk of developing an ectopic pregnancy.

It is unclear why the CDC and other federal agencies across two administrations have failed to publicly respond to the increase in deaths despite having access to the same information ProPublica analyzed. But experts say the country’s capacity to respond to it has been greatly reduced under President Donald Trump.

Robert F. Kennedy Jr., secretary of the Department of Health and Human Services, told Congress in April that improving maternal health outcomes is a priority. But the Trump administration has eliminated much of the staff devoted to researching the topic and cut hundreds of millions of dollars in government funding for healthcare research.

The CDC’s Division of Reproductive Health, for example, lost most of its 100 employees, according to a lawsuit filed by more than a dozen states’ attorneys general last year. The entire division that ran the Pregnancy Risk Assessment Monitoring System, a significant source of data for state and local governments as well as maternal health researchers, is on paid administrative leave. That includes many researchers who would have been responsible for investigating the rise in ectopic pregnancy deaths, according to current and former CDC employees.

“You’re losing the capacity to know what’s going on with pregnant women,” Lee Warner, the former chief of the Women’s Health and Fertility Branch at the CDC, said of the cuts at the division. “It’s going to take decades to build this capacity back.”

Funding cuts have also impacted efforts to raise awareness about the condition. Because ectopic pregnancies usually cause complications before standard prenatal care begins around 10 weeks, patients often rely on emergency departments, where doctors don’t typically have specialized training in pregnancy care. Experts say more training on high-risk early pregnancy conditions could help combat rising maternal mortality rates.

Tami Chappell/Reuters/File

CDC’s annual abortion report delayed amid agency turmoil

The CDC in 2025 also stopped funding a partnership with the American College of Obstetricians and Gynecologists to educate emergency medicine doctors about reproductive healthcare. The initiative, “ Obstetric Emergencies in Nonobstetric Settings ,” offers resources for emergency departments on caring for pregnant patients with cardiovascular disease, hypertension and eclampsia. An ACOG spokesperson said its foundation now funds the project, and that the organization is working on a set of guidelines for diagnosing and managing tubal ectopic pregnancies in the emergency department.

A spokesperson for HHS said the agency continues to track maternal mortality trends, investigate their causes and provide funding for research. “This important work is being accelerated across the Department to support healthy mothers, healthy babies, and strong families,” the spokesperson said.

The United Kingdom’s response to a similar spike in ectopic deaths during the pandemic shows just how much the U.S. is failing to do.

Researchers and officials there identified a surge in deaths in 2021 and 2022 in the U.K. and Ireland; 12 women died of an ectopic pregnancy during those years, which, as in the U.S. during this period, represented a near doubling of the death rate compared with previous years.

They investigated the causes and found a range of culprits, including overstretched emergency services and inadequate early pregnancy screenings, says Marian Knight, a professor at the University of Oxford who leads the U.K.’s maternal mortality reporting.

In 2024, Knight co-authored a maternal mortality report that focused on those deaths and offered policy recommendations. Knight worked with policymakers and a U.K. charity to raise awareness and help doctors and the general public recognize ectopic pregnancy symptoms. Officials also changed how patients experiencing ectopic pregnancy symptoms are prioritized when they call for an ambulance, leading to faster response times.

But the first step, said Knight, was identifying and investigating the issue. “If we’re not tracking and not just understanding the numbers, but understanding the why behind the numbers, we have no ability to respond,” Knight said.

The U.S. doesn’t do national maternal mortality reviews, said Boston University’s Declercq, who serves on the Massachusetts Maternal Mortality and Morbidity Review Committee. Instead, CDC epidemiologists review death and birth records to establish accurate national totals of pregnancy-related deaths, largely leaving state and local maternal mortality committees to take an in-depth look at individual cases and make recommendations to lawmakers and medical providers.

Declercq said his committee has not identified a notable increase in deaths from ectopic pregnancies in Massachusetts in recent years. In most states, these deaths are sporadic enough that they don’t, in isolation, show a notable trend.

It’s only at the national level that this increase in avoidable deaths becomes visible.

ProPublica’s analysis “raises concern that young women are dying from a preventable cause at an increasing rate,” Schreiber, the professor of OB-GYN, said. “That is not what we should be seeing in the United States of America.”

To tabulate deaths involving ectopic pregnancies, we used the CDC’s multiple cause of death database in its WONDER tool. First we set the filters to include any record with an “O00” ICD 10 code, which corresponds to the condition. To reduce the likelihood of data errors, we further filtered to records of females between the ages of 10 and 54. While reporting practices for pregnancy-related deaths have changed in the past decade, experts told us those changes were unlikely to have impacted how ectopic pregnancy deaths were recorded.

Given that these are relatively rare events, we grouped the results to multiyear intervals to smooth out year-to-year variations and ensure that figures were above the suppression threshold of 10. Our analysis found that 196 deaths involving the condition were recorded from 2020 to 2026, compared with 106 in the previous six-year period.

We also compared outcomes in two groups of states. One constituted states that enacted and enforced strict abortion bans, which we defined as those that began at six weeks of pregnancy or earlier, for a significant period of time after the Supreme Court’s Dobbs decision, which overturned Roe v. Wade, in 2022. This group included Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas and West Virginia.

The other group included states that never enacted any abortion bans after the Supreme Court’s Dobbs decision: Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington and Wyoming. This analysis excluded a handful of states — Arizona, Nebraska, North Carolina, Ohio, Utah and Wisconsin — with bans starting after six weeks or with bans that were either struck down quickly or never went into effect, as experts told us it would be most instructive to look at states with restrictions that overlap with the early pregnancy period when ectopics typically cause complications. Deaths were tabulated by state of residence.

To standardize the comparison between states and across years, we calculated a death rate based on the corresponding number of live births, which was also compiled from a CDC WONDER database.

To understand Texas ectopic pregnancy hospitalizations, we used de-identified billing records for encounters at all hospitals in the state between 2018 and 2024 that we purchased from the Texas Department of State Health Services. We included records of inpatient stays and emergency department visits for patients identified as females of reproductive age, between 10 and 54.

Within those hospitalizations, we narrowed our analysis to any encounter with a diagnosis code indicating an ectopic pregnancy. We found about 46,000 total hospitalizations, 80% of which took place in the emergency department. Between 2018 and 2024, the number of encounters with an ectopic pregnancy diagnosis increased by 27%. The dataset did not have a unique patient identifier, so we could not assess how much of that increase represented patients coming back to the hospital more times before receiving care.

Within that subset of hospitalizations, we identified encounters where the patient had significant blood loss; since there is no diagnosis code indicating a ruptured ectopic pregnancy, we looked for severe complications associated with a rupture. First, we identified every encounter where a patient received a blood transfusion, using a list of codes defined in a methodology used by researchers as well as federal and state governments to identify severe complications in childbirth . Next, we identified encounters with a diagnosis code indicating a hemorrhage. We used a list of hemorrhage codes defined in the same childbirth complication methodology, then added a handful of codes pertaining to severe blood loss in early pregnancy that we’d identified with the help of doctors and researchers who study claims data — for example, “delayed or excessive hemorrhage following ectopic and molar pregnancy.”

If a patient with an ectopic pregnancy had either a transfusion or a diagnosis code indicating a hemorrhage or both, we considered that to be an indicator that the patient had experienced significant blood loss.

More than a dozen experts in epidemiology and maternal health reviewed our findings and offered guidance as we developed our methodology, including Dr. Alice Abernathy, Suzanne Bell, Alison Gemmill, Caitlin Myers, Maria Steenland, Dr. Debra Stulberg, Marie Thoma and Ushma Upadhyay.

图片来源/Photodisc/Getty Images

本文最初由非营利新闻机构ProPublica发布，该机构致力于调查滥用职权的行为。订阅即可第一时间获取其重要报道。

ProPublica的一项分析发现，近年来宫外孕后死亡的女性人数激增。美国疾病控制与预防中心的数据显示，不断攀升的死亡人数却鲜少引起关注或采取应对措施。

此类死亡通常发生在妊娠早期，即受精卵未能正常着床于子宫内，转而在其他部位发育，最常见的是在输卵管内。胚胎不断生长，直至导致输卵管破裂，引发灾难性出血。

孕产妇健康专家表示，只要及时获得适当的医疗护理，女性就不会死亡。然而，ProPublica 的分析却发现死亡人数出现了令人震惊且匪夷所思的增长：从 2020 年到 2025 年，患有此病的女性死亡人数接近 200 人，而此前六年这一数字约为 100 人。

“与宫外孕相关的死亡事件本应是绝不应该发生的，”费城妇产科医生爱丽丝·阿伯纳西博士说。

虽然 COVID-19 大流行期间医院的混乱和就医困难可能至少导致了部分死亡，但死亡人数的激增仍在持续，这引发了人们对近年来对孕产妇保健造成最大干扰的因素——各州对堕胎的限制——所起作用的严重质疑。

对于几乎不可能存活的宫外孕，医生必须终止妊娠。但诉讼和联邦投诉指控，在一些因实施堕胎而面临刑事处罚的州，一些医疗机构对终止妊娠犹豫不决，甚至断然拒绝。患者们描述了她们的恐惧。

“我当时真的以为自己要死了，”凯莉·瑟曼说道。2023 年，她在德克萨斯州寻求宫外孕治疗的过程中遭遇困难，导致右侧输卵管破裂。

“有好几次我都问过我丈夫我是不是要死了，”来自俄克拉荷马州的莱塔娅·洛里莫尔在2月份因宫外孕被多家医院拒绝治疗后提起的诉讼中说道。“我一直在想着我们的孩子。”

为了确定这些问题是否仅仅是个别案例，ProPublica 分析了美国疾病控制与预防中心（CDC）从各州收集的数据，以寻找其中的规律。分析结果显示，在堕胎禁令严格的州，女性的处境与那些没有堕胎禁令的州相比，差距日益扩大。

虽然宫外孕死亡人数在全国范围内都有所上升，但在最高法院于 2022 年推翻罗诉韦德案后禁止堕胎的各州，宫外孕死亡人数的上升幅度要大得多。

ProPublica 将其分析结果分享给了十几位孕产妇健康专家，其中包括该领域的领军人物，但他们都不知道这一激增；早期妊娠并发症长期以来研究不足。

虽然他们警告说，仅凭堕胎禁令无法解释全国堕胎率的上升，但孕产妇健康专家表示，对堕胎率激增的任何调查都应该包括法律造成的护理延误，包括宫外孕的护理延误。

在瑟曼的案例中，尽管她出现了明显的宫外孕迹象，但两家急诊科都未解决并发症就让她回家了。监管机构在2025年发现，其中一家医院——Ascension Seton Williamson医院——未能对瑟曼进行适当的宫外孕筛查，也没有联系妇产科医生，这违反了医院自身的规章制度和联邦法律。联邦法律要求急诊科在患者出院前必须对其进行治疗并稳定病情。瑟曼目前已对Ascension Seton Williamson医院和另一家医院——Ascension Seton Highland Lakes医院——提起医疗事故诉讼。

瑟曼的输卵管破裂后不得不切除。（瑟曼与安珀·瑟曼没有亲属关系，安珀·瑟曼于2022年在佐治亚州去世，该州也禁止堕胎，死因是医生延误了对她各种妊娠并发症的治疗。）

“我从来没有遇到过需要医疗保健却得不到的情况，”瑟曼告诉 ProPublica，她将这种情况比作“一颗你无法控制的定时炸弹”。

Ascension Seton医院的一位发言人在一份声明中表示：“当患者在怀孕期间出现严重或危及生命的状况时，我们的临床医生会提供必要的医疗治疗，包括宫外孕的治疗。”该医院已在法庭文件中否认了瑟曼提出的医疗事故指控。

异位妊娠虽然罕见，但长期以来一直被认为是孕早期孕产妇死亡的主要原因。在美国，高达2%的妊娠会受到异位妊娠的影响。由于政府机构并未要求医院追踪或报告异位妊娠的总体诊断情况，因此我们无法得知异位妊娠本身是否正在变得更加普遍。

虽然疫情期间其他与妊娠相关的死亡率也有所上升，但这些上升趋势已基本平息。

专家尚不确定宫外孕死亡人数持续上升的原因。分析显示，宫外孕在年长女性中更为常见，但年轻女性的死亡人数增幅更为显著。

Aliaksei Smalenski/Adobe Stock

堕胎法也会影响那些试图怀孕的人。

反堕胎团体认为，使用网上处方堕胎药会导致更多宫外孕未被诊断出来，因为远程医疗患者无法接受超声检查。但研究发现，寻求药物流产的人群中宫外孕的发生率远低于普通人群。加州大学旧金山分校研究远程医疗堕胎的研究员乌什玛·乌帕迪亚伊（Ushma Upadhyay）表示，远程医疗诊所会询问一些问题，筛选出宫外孕风险较高的患者，并对接受治疗的患者进行随访，筛查相关症状。

专家告诉ProPublica，需要开展更多研究来确定堕胎禁令在宫外孕相关死亡人数上升中所起的作用。许多实施堕胎禁令的州，通常为低收入女性提供的医疗补助资金和覆盖范围较少，长期以来孕产妇健康状况较差。“要从众多损害这些州女性健康的因素中找出具体原因，确实是一项挑战，”波士顿大学公共卫生研究员尤金·德克勒克（Eugene Declercq）说道。

但专家表示，ProPublica 的数据分析，以及有关宫外孕治疗延误的报道，凸显了找出导致死亡的原因的必要性。

“考虑到政策变化对患者所能获得的护理的影响之快，生殖健康在整个医学领域都是一个特殊领域，”妇产科教授 Courtney Schreiber 博士说。

达特茅斯学院研究堕胎政策的经济学家凯特琳·迈尔斯表示，应该对这些死亡事件进行调查：“这可能是该法规带来的深远后果，”她说。

许多州的堕胎禁令都包含宫外孕的例外条款。但专家担心，医生在没有确凿诊断的情况下不愿提供治疗，而临床医生表示，确诊需要时间，并且会增加母亲的风险。

宫外孕的症状通常始于腹痛和出血，这些症状会导致女性被送往急诊室。在那里，医生会使用超声波检查来确定妊娠着床的位置。

然而，在怀孕早期，胚胎通常无法通过超声检查看到。这可能意味着宫外孕，但也可能是流产或正常的妊娠，只是胚胎太小而无法被观察到。医生还可以通过连续多日的血液检查来评估是否可能是宫外孕。

如果是宫外孕，治疗拖延的时间越长，破裂的风险就越高。在没有禁令的州，患者可以随时决定这种风险不值得承担，并选择终止妊娠。

然而，在禁止堕胎的州，这种选择可能并不存在。如果医生能通过超声波检查确认是宫外孕，他们就可以避免因终止妊娠的决定而受到质疑，尤其是一些热心的检察官可能会提出质疑。但等待超声波检查结果可能会使治疗延误数天甚至数周。

Kathleen Flynn 为 ProPublica 撰稿

她面临危及生命的流产。由于阿肯色州的堕胎禁令，即使打电话给州长办公室也无济于事。

“发现肿块并不是高度怀疑宫外孕的唯一原因，”纽约急诊医学医生、Access Bridge临床主任Rebecca Nerenberg博士说。Access Bridge致力于为急诊医生提供生殖保健方面的教育，并发布了基于证据的宫外孕诊断指南。

专家表示，如果出现其他症状，例如妊娠激素水平停滞不前、出血和腹痛，医生应该能够提供治疗。患者可以通过手术或服用抑制癌细胞生长的抗癌药物进行治疗。

但对于堕胎禁令州的女性来说，获得这种治疗可能很困难。

居住在俄克拉荷马州州界附近的洛里莫尔 (Lowrimore) 今年二月因腹痛和大量出血前往阿肯色州一家急诊室就诊。根据诉讼文件，她被诊断为“妊娠位置不明”，因为超声波检查无法显示胚胎着床位置，之后便被送回家进行进一步检查。

根据诉讼文件，在接下来的一周里，洛里莫尔先后前往这两个州的三个不同的医院就诊，因为她开始排出血块，疼痛加剧，并向上放射到她身体的左侧。

尽管医生承认宫外孕是一种可能的诊断，但各州堕胎禁令中对宫外孕有所例外，这对她来说并无帮助。每次就诊，医生都没有针对宫外孕进行治疗。其中一位医生告诉她，干预她的妊娠可能会让他坐牢——“十年监禁”，诉讼书中如此写道。“我觉得我的生命对他来说是一个他无法承受的风险，”她在诉讼文件中写道。

在咨询了律师之后，洛里莫尔最终驱车前往堪萨斯州的一家医院（堕胎在堪萨斯州是合法的），并在抵达后几个小时内注射了名为甲氨蝶呤的抗癌药物。

洛里莫尔的诉讼仍在进行中，该诉讼由一名妇产科医生和六名被拒绝就医的女性共同提起，旨在阻止阿肯色州的堕胎禁令生效。洛里莫尔还根据与瑟曼相同的紧急医疗法，对三家医院提起了投诉。监管机构指出，位于阿肯色州史密斯堡的仁慈医院在洛里莫尔等待就诊的八小时内未能提供医疗服务。另外两家医院未被认定违反该法律，且未回应置评请求。

仁慈医院的一位发言人拒绝就此案发表评论，称“在孕妇遭遇紧急、危及生命的疾病等悲剧情况下，仁慈医院会提供所有必要的医疗治疗来挽救她的生命。”

许多专家预测，堕胎禁令生效后，像洛里莫尔和瑟曼所描述的那种磨难将会出现。为了了解是否有更多宫外孕女性出现严重的健康后果，ProPublica 分析了德克萨斯州（人口最多的堕胎禁令州）的医院数据。

ProPublica 的这项最新分析发现，与 2018 年和 2019 年相比，2023 年和 2024 年德克萨斯州因宫外孕导致大量出血的患者增加了 310 例，增幅约为 29%。与宫外孕死亡病例类似，并发症的增加似乎始于新冠疫情期间，但在医院系统恢复正常且该州通过限制性堕胎法后，并发症发生率仍然居高不下。ProPublica 正在努力从没有堕胎禁令的州获取类似数据。

针对 ProPublica 对德克萨斯州堕胎禁令造成的致命影响的报道，该州于 2025 年通过了《母亲生命法案》，试图明确该州法律允许哪些类型的堕胎，并明确将宫外孕添加到列表中。

但德克萨斯州医学委员会的新指南仅包含一个可通过超声波检查发现的异位妊娠病例，却对早期超声波检查难以确定妊娠着床位置的问题只字未提。这使得检察官有可能质疑此类病例是否真的是异位妊娠，因为在该州，医生若实施非法堕胎将面临最高99年的监禁。

Lexi Parra 为 ProPublica 撰稿

“定时炸弹”：一名怀孕母亲病情持续恶化，最终因无法在德克萨斯州堕胎而去世。

德克萨斯州医学委员会发言人表示，该课程并非旨在涵盖所有情况，而是“解释了无需立即造成伤害，并明确指出，遵循循证医学、标准急救流程和正确记录的医生面临的风险极低。” 当被问及确诊异位妊娠是否需要确凿的超声图像时，该发言人表示：“委员会一直认为，对每一种可能的情况都进行评论是不切实际的。”

但代表瑟曼和其他13名德克萨斯州女性或其家人的律师米歇尔·马洛尼表示，她仍然经常接到女性的电话，她们声称自己因妊娠并发症而被拒绝治疗。这些女性或她们的家人表示，她们被拒绝提供医疗服务，其中包括7名宫外孕患者。“我认为具体的豁免条款并不能解决妊娠过程中出现的各种灰色地带，”她说。

各州自身不太可能找到解决方案。此前ProPublica的一项调查发现，那些实施严格禁令的州并没有研究其法律是否导致了孕产妇死亡。其他州也没有效仿德克萨斯州，尝试修改其禁令。

全国范围内降低宫外孕死亡率的最大挑战之一是缺乏认识、研究和数据。

例如，据 ProPublica 对孕产妇健康统计数据的审查和对专家的采访显示，没有人追踪经历过宫外孕的女性是否也存在一种或多种常见风险因素，例如宫外孕史、不孕症或使用激素宫内节育器。

目前尚无已发表的研究探讨近期异位妊娠死亡率与淋病和衣原体感染等未经治疗的感染之间的联系。这些感染在疫情初期曾大幅增加，之后有所下降。这些感染可导致盆腔炎，进而造成输卵管瘢痕，并增加长期发生异位妊娠的风险。

目前尚不清楚为何疾控中心和其他联邦机构在两届政府执政期间，尽管掌握了与ProPublica分析的相同信息，却未能就死亡人数的增加做出公开回应。但专家表示，在唐纳德·特朗普总统的领导下，美国的应对能力已大幅下降。

美国卫生与公众服务部部长小罗伯特·F·肯尼迪四月份在国会作证时表示，改善孕产妇健康状况是当务之急。但特朗普政府却裁减了大量致力于该领域研究的人员，并削减了数亿美元的政府医疗保健研究经费。

例如，据去年十几个州的检察长提起的一项诉讼称，美国疾病控制与预防中心（CDC）生殖健康部门失去了其100名员工中的大多数。负责运营妊娠风险评估监测系统（该系统是州和地方政府以及孕产妇健康研究人员的重要数据来源）的整个部门目前都处于带薪行政休假状态。据CDC现任和前任员工透露，这其中包括许多原本负责调查宫外孕死亡人数上升情况的研究人员。

“你们正在失去了解孕妇状况的能力，”美国疾病控制与预防中心妇女健康与生育部门前主任李·华纳在谈到该部门的裁员时说。“重建这种能力需要几十年的时间。”

经费削减也影响了提高公众对宫外孕认识的工作。由于宫外孕通常会在孕10周左右开始常规产前检查之前引发并发症，患者往往只能求助于急诊科，而急诊科医生通常缺乏孕期护理方面的专业培训。专家表示，加强对高危早期妊娠疾病的培训有助于降低不断上升的孕产妇死亡率。

塔米·查佩尔/路透社/档案照片

美国疾控中心年度堕胎报告因机构内部动荡而推迟发布

美国疾病控制与预防中心（CDC）于2025年停止资助与美国妇产科医师学会（ACOG）合作开展的一项旨在为急诊医生提供生殖健康教育的项目。该项目名为“非产科环境下的产科急症”，旨在为急诊科提供资源，指导其如何照护患有心血管疾病、高血压和子痫的孕妇。ACOG发言人表示，该项目目前由其基金会资助，并且该组织正在制定一套在急诊科诊断和处理输卵管异位妊娠的指南。

美国卫生与公众服务部（HHS）发言人表示，该机构将继续追踪孕产妇死亡率趋势，调查其原因，并为相关研究提供资金。“为了支持母亲健康、婴儿健康以及家庭美满，该部门正在加快推进这项重要工作，”发言人说。

英国在疫情期间应对类似异位妊娠死亡病例激增的措施，恰恰表明了美国在这方面做得多么糟糕。

研究人员和官员发现，2021 年和 2022 年英国和爱尔兰的死亡人数激增；这两年共有 12 名妇女死于宫外孕，与美国同期的情况一样，死亡率几乎是往年的两倍。

牛津大学教授、英国孕产妇死亡率报告负责人玛丽安·奈特表示，他们调查了原因，发现了一系列罪魁祸首，包括不堪重负的紧急服务以及不足的早期妊娠筛查。

2024年，奈特与人合著了一份孕产妇死亡率报告，重点关注孕产妇死亡事件并提出政策建议。奈特与政策制定者和一家英国慈善机构合作，提高公众意识，帮助医生和普通民众识别宫外孕症状。此外，相关部门还调整了出现宫外孕症状的患者拨打急救电话时的优先顺序，从而加快了急救响应速度。

但奈特表示，第一步是找出并调查问题所在。“如果我们不追踪数据，不去理解数据背后的原因，我们就无法做出应对。”奈特说道。

波士顿大学的德克勒克（Declercq）表示，美国不进行全国性的孕产妇死亡率审查。德克勒克是马萨诸塞州孕产妇死亡率和发病率审查委员会的成员。美国疾病控制与预防中心（CDC）的流行病学家会审查死亡和出生记录，以确定全国孕产妇相关死亡的准确总数，而州和地方的孕产妇死亡率委员会则主要负责深入调查个案，并向立法者和医疗机构提出建议。

德克勒克表示，他的委员会并未发现近年来马萨诸塞州因宫外孕导致的死亡人数显著增加。在大多数州，这类死亡病例较为零星，单独来看并不构成明显的趋势。

只有在国家层面，这种可避免死亡人数的增加才会显现出来。

妇产科教授施赖伯表示，ProPublica的分析“令人担忧，年轻女性死于可预防疾病的比例正在上升”。“这不应该发生在美国。”

为了统计涉及异位妊娠的死亡病例，我们使用了美国疾病控制与预防中心（CDC）的WONDER工具中的多重死因数据库。首先，我们将筛选条件设置为包含所有ICD-10编码为“O00”的记录，该编码对应于异位妊娠。为了降低数据错误的可能性，我们进一步筛选，仅纳入10至54岁女性的记录。尽管过去十年中与妊娠相关的死亡报告方式有所改变，但专家告诉我们，这些改变不太可能影响异位妊娠死亡病例的记录方式。

鉴于这些事件相对罕见，我们将结果按多年间隔分组，以消除年度波动，并确保数字高于 10 的抑制阈值。我们的分析发现，2020 年至 2026 年期间记录了 196 例与该疾病相关的死亡，而前六年期间为 106 例。

我们还比较了两组州的选举结果。一组州是在最高法院于2022年推翻“罗诉韦德案”的“多布斯案”判决后，在相当长的一段时间内颁布并执行了严格的堕胎禁令。我们将其定义为从怀孕六周或更早开始实施的禁令。这组州包括阿拉巴马州、阿肯色州、佛罗里达州、佐治亚州、爱达荷州、印第安纳州、爱荷华州、肯塔基州、路易斯安那州、密西西比州、密苏里州、北达科他州、俄克拉荷马州、南卡罗来纳州、南达科他州、田纳西州、德克萨斯州和西弗吉尼亚州。

另一组包括最高法院在多布斯案判决后从未颁布任何堕胎禁令的州：阿拉斯加州、加利福尼亚州、科罗拉多州、康涅狄格州、特拉华州、哥伦比亚特区、夏威夷州、伊利诺伊州、堪萨斯州、缅因州、马里兰州、马萨诸塞州、密歇根州、明尼苏达州、蒙大拿州、内华达州、新罕布什尔州、新泽西州、新墨西哥州、纽约州、俄勒冈州、宾夕法尼亚州、罗德岛州、佛蒙特州、弗吉尼亚州、华盛顿州和怀俄明州。这项分析排除了少数几个州——亚利桑那州、内布拉斯加州、北卡罗来纳州、俄亥俄州、犹他州和威斯康星州——这些州的堕胎禁令要么在怀孕六周后生效，要么很快就被推翻，要么从未生效。专家告诉我们，研究那些限制措施与早期妊娠期重叠的州最有意义，因为在早期妊娠期，宫外孕通常会引发并发症。死亡人数按居住州统计。

为了使各州之间以及各年份之间的比较标准化，我们根据相应的活产数计算了死亡率，该活产数也是从 CDC WONDER 数据库中收集的。

为了解德克萨斯州异位妊娠住院情况，我们使用了从德克萨斯州卫生服务部购买的2018年至2024年间该州所有医院的去标识化账单记录。我们纳入了年龄在10至54岁之间的育龄女性患者的住院和急诊就诊记录。

在这些住院病例中，我们将分析范围缩小到所有诊断代码提示异位妊娠的就诊记录。我们发现总共有约 46,000 例住院病例，其中 80% 发生在急诊科。2018 年至 2024 年间，异位妊娠诊断的就诊次数增加了 27%。由于数据集中没有唯一的患者标识符，我们无法评估这部分增长有多少是由于患者在接受治疗前多次返回医院所致。

在这些住院病例中，我们筛选出患者出现大量失血的病例；由于没有诊断代码表明异位妊娠破裂，我们寻找与破裂相关的严重并发症。首先，我们使用研究人员以及联邦和州政府用于识别分娩严重并发症的方法中定义的代码列表，识别出所有接受输血的病例。接下来，我们识别出诊断代码表明出血的病例。我们使用了同一分娩并发症方法中定义的出血代码列表，然后添加了一些与早期妊娠严重失血相关的代码，这些代码是我们与研究理赔数据的医生和研究人员合作确定的——例如，“异位妊娠和葡萄胎后延迟或过度出血”。

如果异位妊娠患者接受了输血或诊断代码表明出血，或者两者兼有，我们认为这表明该患者经历了严重的失血。

十几位流行病学和孕产妇健康领域的专家审查了我们的研究结果，并在我们制定研究方法时提供了指导，其中包括 Alice Abernathy 博士、Suzanne Bell、Alison Gemmill、Caitlin Myers、Maria Steenland、Debra Stulberg 博士、Marie Thoma 和 Ushma Upadhyay。