Ruptured ectopic pregnancy: risk factors for a life-threatening condition

Ectopic pregnancy is a significant cause of maternal morbidity and mortality. The widely used features to establish the diagnosis of ectopic pregnancy are not always sufficient to predict rupture.

To determine the risk factors for rupture of an ectopic pregnancy to help physicians identify those women who are at greatest risk.

The study group comprises the cases of ectopic pregnancy who were treated in the gynecologic department of the General Hospital "George Gennimatas" in Athens, Greece, from January 1988 to December 2006. The following parameters were retrospectively examined: rupture status, past history of pelvic infection or ectopic pregnancy, use of IUCD, operations for infertility treatment/tubal surgery, parity and gestational age. The study group was divided into two subgroups: ruptured ectopic pregnancies and unruptured ectopic pregnancies. Where appropriate, Student's t test, Mann-Whitney-Wilcoxon test for independent samples, Pearson's chi-square and Fisher's exact test were applied. Statistical analysis was performed with STATA 8.0 statistical software.

Two hundred and twenty-three cases of ectopic pregnancy were retrieved in the studied period. One hundred and forty-four (65%) of them were cases with ruptured ectopic pregnancies and 79 (35%) were cases with unruptured ectopic pregnancies. Fifty-five of the 144 patients (38.2%) with ruptured ectopic pregnancy and 18 of the 79 (22.8%) patients with unruptured ectopic pregnancy had a past history of ectopic pregnancy (P = 0.019, Pearson's chi-square). Moreover, there was a statistically significant positive association between rupture and parity (1.19 +/- 1.02 for ruptured cases vs. 0.85 +/- 0.89 for unruptured cases; P = 0.015, Mann-Whitney-Wilcoxon test for independent samples). A positive association of borderline significance existed between rupture and gestational age (53.9 +/- 4.7 vs. 52.9 +/- 4.9 days; P = 0.093, Mann-Whitney-Wilcoxon test for independent samples). No statistically significant associations were found concerning past history of pelvic infection, use of IUCD and operations for infertility treatment-tubal surgery.

Previous history of ectopic pregnancy and parity seem to be significant risk factors for rupture of an ectopic pregnancy.