Predictors of Tubal Rupture in Ectopic Pregnancy: A Retrospective Analysis of Clinical and Laboratory Factors

Tubal rupture is a major cause of intra-abdominal hemorrhage and maternal mortality in early pregnancy. Early identification of high-risk patients is clinically important; however, standardized predictive tools integrating multidimensional indicators remain limited, particularly in Chinese populations. The aim of this study was to investigate clinical, laboratory, and ultrasound predictors of tubal rupture in ectopic pregnancy and provide evidence for early risk assessment. This retrospective study included 150 patients with tubal pregnancy treated surgically or medically in our hospital between January 2023 and December 2025. Based on intraoperative findings or ultrasound diagnosis, patients were classified into a ruptured group (n = 51) and an unruptured group (n = 99). Clinical characteristics, laboratory indicators [serum human chorionic gonadotropin (β-hCG), progesterone, hemoglobin, and neutrophil-to-lymphocyte ratio (NLR)], and ultrasound features were analyzed. Univariate and multivariable logistic regression analyses were performed to identify independent risk factors for tubal rupture. Patients in the ruptured group had significantly higher rates of pelvic inflammatory disease (PID) history and moderate-to-severe abdominal pain (P < 0.05). Serum β-hCG and NLR levels were significantly elevated in the ruptured group (P < 0.05). Ultrasound findings showed a larger adnexal mass diameter, greater pelvic fluid depth, and a higher proportion of fetal cardiac activity in ruptured cases (P < 0.05). Multivariable logistic regression identified PID history (odds ratio [OR] = 2.983, 95% confidence interval [CI]: 1.306-6.811, P = 0.009), serum β-hCG > 3,000 IU/L (OR = 4.119, 95% CI: 1.661-10.214, P = 0.002), NLR ≥ 4 (OR = 3.597, 95% CI: 1.613-8.023, P = 0.002), and ultrasonographic detection of a yolk sac (OR = 2.506, 95% CI: 1.015-6.190, P = 0.046) as independent risk factors for tubal rupture. These factors may aid early clinical risk stratification and decision-making.