Risk factors for rupture in tubal ectopic pregnancy: definition of the clinical findings

doi:10.1016/j.ejogrb.2010.08.016

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 154, Issue 1, January 2011, Pages 96-99

https://doi.org/10.1016/j.ejogrb.2010.08.016 Get rights and content

Abstract

Objectives

The aim of this study is to determine the risk factors for rupture of an ectopic pregnancy (EP) to help physicians identify those women who are at greatest risk.

Study design

The study group comprised the cases of EP treated in our department from January 2003 to September 2009. The following parameters were retrospectively examined: rupture status, past history of pelvic infection or EP, use of an intrauterine device (IUD), parity and gestational age. Women with tubal rupture were compared to those without rupture. Where appropriate, univariate and multivariate analyses were used to identify predictors of the outcome of EP.

Results

Two hundred and thirty-two cases of EP were retrieved. Eighty-eight of them (37.9%) were cases with ruptured EP and 144 (62.1%) were cases with unruptured EP. No significant associations existed regarding IUD use, smoking, previous ectopic pregnancy, past history of pelvic inflammatory disease (PID) or history of endometriosis. The mean gestation (in weeks) since the last menstrual period and the mean level of βhCG were significantly higher in patients with ruptured EP compared with patients with unruptured EP (7.8 ± 1.09 versus 6.4 ± 1.2, p < 0.0001; and 8735.3 ± 11317.8 IU/ml versus 4506 ± 5673.7 IU/ml, p < 0.0001, respectively). Logistic regression analysis revealed that 6–8 weeks of amenorrhoea (OR: 3.67; 95% CI: 1.60–8.41) and >8 weeks of amenorrhoea (OR: 46.46; 95% CI: 14.20–152.05) and also 1501–5000 IU/ml of βhCG level (OR: 4.11; 95% CI: 1.53–11.01) and >5000 IU/ml of βhCG levels (OR: 4.40; 95% CI: 1.69–11.46) were the significant risk factors for tubal rupture.

Conclusions

Higher βhCG levels and higher gestational age seem to be significant risk factors for rupture of an EP.

Introduction

Ectopic pregnancy (EP) is any pregnancy in which the fertilized ovum implants outside the uterine cavity. EP remains the leading cause of maternal mortality in the first trimester and accounts for 10–15% of all maternal deaths [1], [2], [3]. Modern advances in ultrasound technology and the determination of serum beta-subunit human chorionic gonadotropin (β-hCG) levels have made it easier to diagnose ectopic pregnancy. The knowledge of risk factors associated with the rupture of an EP may be a valuable tool to identify women at risk for this life-threatening condition. As a result of surgical and medical advances such as laparoscopic management and methotrexate administration, we have seen a decrease in morbidity, lower costs, and fewer hospitalizations resulting from EP. Although it has long been recognized that EP accounts for significant morbidity and mortality, there is still debate about association between β-hCG level and the likelihood of rupture [4], [5], [6], [7], [8], [9], [10]. The widely used tools to establish the diagnosis of EP, such as tubal mass on ultrasound examination, heart rate, blood pressure, hCG and hemoglobin levels, are not always sufficient to predict EP rupture. Knowledge of the risk factors associated with the rupture of an EP may be valuable to identify women who can be treated conservatively. The aim of this study is to determine the clinical and demographic findings in rupture of an EP.

Section snippets

Materials and methods

This is an Institutional Review Board (IRB) approved, retrospective study. The study group comprised the cases of tubal EP who were diagnosed in the gynecologic department of the Haseki Teaching and Research Hospital from January 2003 to September 2009. This hospital is a referral center serving mainly an indigent, low socio-economic population. Inclusion criteria were the following: patients diagnosed as tubal EP and operated by laparotomy or laparoscopy. The study group was divided into two

Results

Two hundred and thirty-two cases of EP were retrieved in the studied period. Eighty-eight of them (37.9%) were cases with ruptured EP and 144 (62.1%) were cases with unruptured EP. The mean age was 29.6 ± 5.6 in patients with ruptured EP and 28.9 ± 5.6 in patients with unruptured EP (p = 0.97). There was no statistically significant association between rupture and age, parity and haematocrit levels (Table 1). No significant associations existed regarding IUD use, smoking, previous EP, past history of

Comments

Determining which tubal pregnancy requires immediate treatment to avoid rupture remains a challenge. The occurrence of tubal rupture in EP ranges from 18.0% to 64.5% as reported in previous large population-based studies [7], [8], [9], [10], [11], [12]. The high rupture rates were explained as secondary to the indigenous population served or to delayed diagnosis caused by lack of diagnostic tools such as transvaginal ultrasound and βhCG measurements. The incidence of tubal rupture was 37.9% in

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Risk factors for rupture in tubal ectopic pregnancy: definition of the clinical findings

Abstract

Objectives

Study design

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Comments

Am J Emerg Med

Eur J Obstet Gynecol Reprod Biol

Obstet Gynecol

Eur J Obstet Gynecol Reprod Biol

Am J Obstet Gynecol

Int J Gynaecol Obstet

Morb Mortal Wkly Rep

The effect of cigarette smoking Chlamydia trachomatis infection, and vaginal douching on ectopic pregnancy

Obstet Gynecol