An ectopic pregnancy is a medical emergency that modern medicine is usually very good at treating. When diagnosed promptly, medication or surgery can prevent the internal bleeding that makes the condition life-threatening.
Yet deaths from ectopic pregnancy are rising in the United States.
A ProPublica analysis of CDC mortality data found that nearly 200 women died following an ectopic pregnancy from 2020 through 2025, almost twice the roughly 100 deaths recorded during the previous six years. The increase was particularly pronounced in states with the strictest abortion restrictions.
The numbers alone cannot establish that abortion laws caused the increase. States differ in access to healthcare, insurance coverage, maternal health outcomes, and other factors that can affect pregnancy-related deaths. But physicians and researchers have documented something that makes the pattern difficult to ignore: delays in treating suspected ectopic pregnancies in states where abortion restrictions have changed how doctors and hospitals respond to uncertain early pregnancies.
More than a dozen maternal health experts contacted by ProPublica said they were unaware of the extent of the increase. Meanwhile, federal programs intended to improve reproductive healthcare training for emergency physicians have been cut back. Pasted markdown
So why are women still dying from a condition doctors know how to treat?
What an ectopic pregnancy is — and why it’s always an emergency
An ectopic pregnancy occurs when a fertilized egg implants and grows in a location that cannot support the pregnancy. More than 90% of ectopic pregnancies occur in a fallopian tube, though they can also implant in the abdomen, cervix, ovary, or cesarean scar.
A tubal ectopic pregnancy is almost never viable and cannot develop into a delivery. The American College of Obstetricians and Gynecologists (ACOG) states explicitly that treatment requires ending the nonviable pregnancy. The two available methods are medication — typically methotrexate, a drug that stops cell growth — or surgery to remove the affected tube or the pregnancy itself.
As the pregnancy grows, it can cause the structure where it has implanted to rupture, triggering severe internal bleeding that threatens life. When the fallopian tube has already ruptured, or when a patient is hemodynamically unstable, surgery is required immediately. The window between symptomatic presentation and a life-threatening rupture can be measured in hours.
The scale of the surge
The national death figures, drawn from the CDC’s WONDER multiple cause of death database, require grouping into multi-year intervals because annual totals for individual states fall below the federal data suppression threshold of 10 cases. Even with that limitation, the trend is unambiguous.
The national ectopic pregnancy death rate reached 9.8 per million live births in the 2023 to 2025 period, a sharp departure from the rates recorded in the preceding decade. Rates of most pregnancy-related deaths increased during the pandemic but have largely subsided; ectopic pregnancy deaths have continued to rise.
In states that enacted and enforced bans beginning at six weeks of pregnancy or earlier, the ectopic pregnancy death rate reached 13.1 per million live births. In states that never enacted a ban after the 2022 Dobbs decision, it was 7.1 — an 85% higher death rate in the most restrictive states compared with states without bans.
Texas provides the most granular picture of what this looks like on the ground. 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. The rate of complications remained elevated after hospital systems stabilized and the state passed its restrictive law.
Clinicians who reviewed the data were direct about what it means. Dr. Courtney Schreiber, a professor of obstetrics and gynecology and Chief of Family Planning at the Perelman School of Medicine, University of Pennsylvania, said the pattern raises concern that young women are dying preventable deaths at a rising rate, and that “is not what we should be seeing in the United States of America.”
How abortion law creates a diagnostic trap
Every state with an abortion ban includes an explicit exception for ectopic pregnancy. In theory, this means ectopic pregnancies are unambiguously legal to treat. In practice, the clinical reality is more complicated.
Abortion bans make exceptions for ectopic pregnancies, but getting a definitive diagnosis can mean waiting days or even weeks, while the risk of rupture and death rises. Ectopic pregnancy cannot always be confirmed on a first ultrasound. Early in gestation, the pregnancy may not yet be visible in the tube. Clinicians must often track serial hCG levels — repeated blood tests measuring pregnancy hormone — over multiple visits before they can confirm location. In a pre-Dobbs environment, many physicians would treat on strong clinical suspicion rather than waiting for an unambiguous result. In states with criminal liability attached to abortion, some are waiting longer.
The case of Kyleigh Thurman in Texas illustrates the stakes of that delay. Despite clear signs of an ectopic pregnancy, two emergency departments sent Thurman home without resolving the complication. A federal investigation by the Centers for Medicare and Medicaid Services found that Ascension Seton Williamson Hospital in Round Rock violated federal law — specifically the Emergency Medical Treatment and Labor Act, which requires emergency departments to provide stabilizing care before discharging patients — by failing to properly screen Thurman and declining to call in an OB-GYN. Her right fallopian tube subsequently ruptured and had to be surgically removed.
A 2025 national survey of emergency physicians, published in the Western Journal of Emergency Medicine, found that 24% of physicians in restrictive or semi-restrictive states reported delays in the management of patients with suspected or confirmed ectopic pregnancy. Fifty-four percent of physicians reported adaptations to care — including repeat testing and arranging alternative care — in cases where they might previously have delivered definitive treatment in the emergency department.
A separate qualitative study conducted by researchers at Beth Israel Deaconess Medical Center, involving 40 physicians across nine states with total abortion bans, documented a similar pattern. Physicians described delays in care for miscarriages, ectopic pregnancies, and other serious pregnancy-related conditions as clinicians sought additional testing, specialist consultation, or approval from hospital attorneys or ethics committees before intervening. Some physicians reported having to wait until patients’ conditions worsened before treatment could be provided under state law, even when the appropriate course of care was already clear.
One OB-GYN quoted in that study described patients who “clearly had ectopics” being “sat on for weeks until they’re clearly ruptured.”
Researchers have also noted that abortion bans are not the only variable. Many states with bans have long had poorer maternal outcomes, including less Medicaid coverage for low-income women. Eugene Declercq, a professor of community health sciences at the Boston University School of Public Health, told ProPublica: “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.” Those confounding factors exist alongside the documented delays and the documented deaths.
The federal response gap
The CDC in 2025 stopped funding a partnership with ACOG to educate emergency medicine doctors about reproductive healthcare. That program was designed to close precisely the training gap that clinicians and researchers cite as a structural contributor to ectopic deaths: ectopic pregnancies typically present before standard prenatal care begins around 10 weeks, which means patients rely on emergency departments where physicians may lack specialized obstetric training.
HHS Secretary Robert F. Kennedy Jr. declared before Congress in April 2026 that improving maternal health outcomes was one of his top priorities. An HHS spokesperson told ProPublica that the agency continues to “track mortality trends, investigate their causes, and provide funding for research.” The agency has not issued any public statement specifically addressing the doubling of ectopic pregnancy deaths. When the administration cut millions of dollars in health care research funding, that included laying off most of the CDC’s Division of Reproductive Health’s 100 employees.
A measurable, worsening trend in a specific cause of first-trimester maternal mortality is recorded in federal databases, acknowledged by researchers, and documented in peer-reviewed literature — with no coordinated institutional response.
Dr. Alice Abernathy, an Assistant Professor of Obstetrics and Gynecology at the Perelman School of Medicine, University of Pennsylvania, captured the clinical consensus: “A death related to ectopic pregnancy should really be a never event.” The United States recorded nearly 200 of them in five years.
What legislative fixes have — and haven’t — achieved
In response to 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 permitted under state law, explicitly adding ectopic pregnancies to the list. The Texas Medical Association noted the law provided greater clarity around medical emergency exceptions and acknowledged that physicians had previously navigated significant uncertainty.
Whether the legislation has had a measurable effect on outcomes is not yet established. The delay is not always a result of physicians refusing to act on principle, but of hospitals and legal teams requiring diagnostic certainty before permitting treatment that might, under a different legal framing, be construed as an abortion. Clarifying that ectopic pregnancy treatment is categorically permitted under state law removes one layer of that ambiguity. It does not address the underlying training gap, the CDC funding cuts, or the broader erosion of the maternal health infrastructure.
Ectopic pregnancy is common enough that emergency physicians in any active department will encounter it regularly. The question is whether they are equipped to act on clinical suspicion quickly enough to prevent the outcome that, according to ACOG, should never happen at all.
A Treatable Emergency, but Timing Matters
Ectopic pregnancy can become deadly when diagnosis or treatment comes too late. Warning signs can include pelvic or abdominal pain, often on one side, along with vaginal bleeding during early pregnancy. Shoulder pain, weakness, dizziness, or fainting can be signs of internal bleeding and require immediate medical attention.
The rise in deaths doesn’t have a single proven explanation. States with abortion bans often differ from other states in healthcare access, insurance coverage, maternal health outcomes, and other factors that make determining cause difficult.
At the same time, the evidence of treatment delays can’t simply be dismissed. Emergency physicians have reported changing how they manage suspected ectopic pregnancies in restrictive states, and physicians interviewed in peer-reviewed research have described waiting for additional tests, consultations, or legal approval before providing care. Pasted markdown
That makes the national increase an important warning sign, even before researchers can determine exactly how much each factor contributed.
Dr. Alice Abernathy, an OB-GYN at the University of Pennsylvania, told ProPublica that a death from ectopic pregnancy should be a “never event.” Pasted markdown
Nearly 200 deaths between 2020 and 2025 show that the United States is falling short of that standard. Understanding why, and whether changes in healthcare access, emergency medicine, and abortion policy are contributing, could help determine how many future deaths can be prevented.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
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