Recommended Citation
Inamdar N, Primuth H, Adefisoye JO, Kram JJF, Bruce E, Forgie M. Implications of the Dobbs vs. Jackson Women's Health Organization Decision on the Incidence Rate of Ruptured Ectopic Pregnancies. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Ectopic pregnancy (EP) requires timely diagnosis and treatment as delays increase the risk of rupture and maternal morbidity/mortality. Delays to reproductive healthcare access due to legal ambiguity, clinic closures, and widespread misinformation post-Dobbs vs. Jacksonmay have increased the incidence of ruptured EPs in Wisconsin. Similar delays may have also been experienced during COVID- 19 increasing ruptured EPs.
Purpose:
To examine the impact of restricted reproductive healthcare access in Wisconsin post-Dobbson EP rupture incidence proportion (IP), presentation, and management.
Methods:
Our retrospective cohort study looked at EPs within one healthcare system at 63 facilities located predominately in Southeastern Wisconsin across 3 segmented study periods of 15, 27, and 15 months, respectively: 1-pre-Dobbsand no COVID-19 restrictions, 1/1/2019-3/31/2020; 2-pre-Dobbsand COVID-19 restrictions, 4/1/2020-6/30/2022; and 3-post-Dobbsand no COVID-19 restrictions, 7/1/2022-9/30/2023. Using ICD-10–identified cases, we calculated the IP of ruptured EPs by time, and assessed differences in presentation and management, including demographics, gestational age, laboratory values, blood loss, and transfusion needs. We fitted a weighted segmented linear regression interrupted time series (ITS) allowing for the assessment of immediate change in proportion and change in trend following the interventions. The significance level was set at α=0.05.
Results:
We identified a total of 913 EPs. There were no significant differences in the IP of ruptured EPs among the three periods (49.1% vs 44.3% vs 44.6%, p = 0.46). Results from ITS showed that the baseline rupture IP was about 49.7%. The outbreak of COVID-19 led to no significant immediate level change in IP of ruptured EPs (β = -4.27, 95% CI -19.13 to 10.59, p = 0.58), nor a change in trend (β = 0.02, 95% CI -1.48 to 1.52, p = 0.98). Dobbsalso led to no significant immediate level change in IP of ruptured EPs (β = -3.84, -18.03 to 10.35, p = 0.60), nor a change in trend (β = 0.58, 95% CI -0.83 to 2.00, p = 0.42). There were no differences in demographics, gestational age, laboratory values, blood loss, and transfusion needs across the time periods (all p’s > 0.05).
Conclusion:
Despite increased challenges and barriers to care post-Dobbsand during COVID-19, our study found no evidence of baseline trend or level/trend changes in EP rupture IP, suggesting our system continued to provide comprehensive care.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Implications of the Dobbs vs. Jackson Women's Health Organization Decision on the Incidence Rate of Ruptured Ectopic Pregnancies
Background/Significance:
Ectopic pregnancy (EP) requires timely diagnosis and treatment as delays increase the risk of rupture and maternal morbidity/mortality. Delays to reproductive healthcare access due to legal ambiguity, clinic closures, and widespread misinformation post-Dobbs vs. Jacksonmay have increased the incidence of ruptured EPs in Wisconsin. Similar delays may have also been experienced during COVID- 19 increasing ruptured EPs.
Purpose:
To examine the impact of restricted reproductive healthcare access in Wisconsin post-Dobbson EP rupture incidence proportion (IP), presentation, and management.
Methods:
Our retrospective cohort study looked at EPs within one healthcare system at 63 facilities located predominately in Southeastern Wisconsin across 3 segmented study periods of 15, 27, and 15 months, respectively: 1-pre-Dobbsand no COVID-19 restrictions, 1/1/2019-3/31/2020; 2-pre-Dobbsand COVID-19 restrictions, 4/1/2020-6/30/2022; and 3-post-Dobbsand no COVID-19 restrictions, 7/1/2022-9/30/2023. Using ICD-10–identified cases, we calculated the IP of ruptured EPs by time, and assessed differences in presentation and management, including demographics, gestational age, laboratory values, blood loss, and transfusion needs. We fitted a weighted segmented linear regression interrupted time series (ITS) allowing for the assessment of immediate change in proportion and change in trend following the interventions. The significance level was set at α=0.05.
Results:
We identified a total of 913 EPs. There were no significant differences in the IP of ruptured EPs among the three periods (49.1% vs 44.3% vs 44.6%, p = 0.46). Results from ITS showed that the baseline rupture IP was about 49.7%. The outbreak of COVID-19 led to no significant immediate level change in IP of ruptured EPs (β = -4.27, 95% CI -19.13 to 10.59, p = 0.58), nor a change in trend (β = 0.02, 95% CI -1.48 to 1.52, p = 0.98). Dobbsalso led to no significant immediate level change in IP of ruptured EPs (β = -3.84, -18.03 to 10.35, p = 0.60), nor a change in trend (β = 0.58, 95% CI -0.83 to 2.00, p = 0.42). There were no differences in demographics, gestational age, laboratory values, blood loss, and transfusion needs across the time periods (all p’s > 0.05).
Conclusion:
Despite increased challenges and barriers to care post-Dobbsand during COVID-19, our study found no evidence of baseline trend or level/trend changes in EP rupture IP, suggesting our system continued to provide comprehensive care.
Affiliations
Aurora Sinai Medical Center, Aurora UW Medical Group