Risk Factors for Rupture of Tubal Ectopic Pregnancy

Abstract

Abstract

Background: Greater gestational age at presentation is associated with a higher risk of rupture of ectopic pregnancy. However, the predictive value of levels of β–human chorionic gonadotropin (β-hCG) and durations of symptoms are more controversial. Objective: The hypothesis for this research was that higher levels of β-hCG and greater gestational age and duration of symptoms are more likely to be associated with tubal rupture. This study was undertaken to test this hypothesis. Materials and Methods: This retrospective review was of medical records of all women who had ectopic pregnancy and were treated at the University Hospital, in Newark, NJ, between January 1, 2005 and February 6, 2013. The collected data were not normally distributed, and statistical assessment was performed using Mann-Whitney–U tests. Results: For this study, 269 medical records were found for review. There were 108 patients with rupture and 161 without rupture. The median duration of symptoms in the group with rupture was 1.0 day and in the group without rupture 2.0 days, (p=0.009). The median β-hCG level for the rupture group was 4630 IU/mL. This median was significantly higher than for the group without rupture, which had a median β-hCG level of 3068 IU/mL (p=0.008). The median gestational age (in weeks) was similar in the two groups: 7 weeks in the group who had rupture and 6.5 in the group without rupture (p=0.31). There was an increased risk of rupture of tubal ectopic pregnancies in patients with higher levels of β-hCG. The group of patients who had rupture had shorter durations of symptoms, rather than the longer duration that was hypothesized. Gestational ages were similar in both groups. Conclusions: Suspicion is the best tool we have to prevent unnecessary morbidity and mortality from ruptured ectopic pregnancies. (J GYNECOL SURG 30:344)