Ruptured tubal ectopic pregnancy: Risk factors and reproductive outcome - Results of a population-based study in France

OBJECTIVE: The aim of this study was to investigate the determinants of tub al rupture and to describe its treatment and effect on subsequent fertility . STUDY DESIGN: The data were taken from a population-based register from Auv ergne (France). All women aged between 15 and 45 years residing permanently in this area and treated for ectopic pregnancy by surgical or medical proc edures have been registered since 1992. They are then followed up prospecti vely until the age of 45 years. This study is an analysis of 849 tubal ecto pic pregnancies registered between January 1992 and December 1996. Women wi th tubal rupture were compared with those in whom no tubal rupture occurred . The risk factors for tubal rupture were identified by calculating crude a nd adjusted odds ratios. The effects of tubal rupture on subsequent fertili ty were assessed by calculating cumulative intrauterine pregnancy rates and were analyzed by log-rank tests and Cox regression. RESULTS: The rate of rupture for this population was 18%. Four factors were identified that increased the risk of rupture (results of the multivariate analysis): never having used contraception (odds ratio 1.7 [1.0 to 3.3]), a history of tubal damage together with infertility (odds ratio 1.6 [0.9 to 2.7]), induction of ovulation (odds ratio 2.5 [1.1 to 5.6]), and a high le vel of beta-human chorionic gonadotropin (at least 10,000 1U/L) when ectopi c pregnancy was suspected (odds ratio 2.9 [1.5 to 5.6]). The overall cumula tive frequency of intrauterine pregnancy was not significantly lower after tubal rupture (adjusted risk ratio 0.85 [0.53 to 1.38]). CONCLUSION: Although tubal rupture seriously affects the immediate health o f the women concerned, it seems to have no independent effect on subsequent fertility. Better knowledge of the risk factors should make it possible to identify those women who will not benefit from nonsurgical treatment.