Ectopic pregnancy rupture – can it be prevented?

Abstract

Objectives: To determine risk factors for ectopic pregnancy (EP) rupture based on the patients history and preoperative tests. Materials and methods: The retrospective study consisted of 175 women operated on due to EP in the Department of Gynecology and Oncology of the Jagiellonian University between 2000-2008. Tubal rupture was diagnosed at the time of surgery. The patients were then divided into three groups: those who had unruptured EP without bleeding, those who had unruptured EP with hemorrhage into peritoneal cavity, and those who suffered ruptured tubal pregnancy. Analysis was performed based on the following parameters: patient history, preoperative laboratory tests (Hb, Hct, βHCG), and ultrasound exam. Results: Of the 175 cases of ectopic pregnancy included in the study, 20% were unruptured without bleeding (A) and 40.6% unruptured with hemorrhage (B) while 39.4% were ruptured (C). There was a positive correlation between the diameter of the tubal lesion measured ultrasonographically and rupture (37.416 for C vs 29.712.9 for A; p=0.04). The gestational age of the groups differed significantly (p=0,001): C (56 1), A (493), and B (422). There was also a positive correlation between rupture and gravidity (11 for A vs 22 for C; p=0.02). Moreover, a positive correlation of borderline significance was discerned between rupture and parity (p=0.06). Additionally, the preoperative hemoglobin and hematocrit values were significantly lower in the rupture group (p=0.001).There was no significant difference among the three groups in age, number of abortions, serum βHCG, endometrial thickness, length of hospital stay, or the time elapsed since the most recent pregnancy. Conclusions: Low hemoglobin and hematocrit values, together with higher gravidity at the time of admission, may indicate an increased risk of tubal rupture.