A STUDY OF RUPTURED TUBAL ECTOPIC PREGNANCY

Objective: Ectopic pregnancy continues to be a leading cause of matern al morbidity and of reduced childbearing potential among women of repr oductive age. Because of tubal rupture, it is still the main cause of pregnancy-related death during the first trimester. The purpose of our study was to evaluate factors that may predispose a woman to rupture of a tubal ectopic pregnancy. Methods: In this retrospective study of 693 ectopic pregnancies from three McGill University teaching hospital s, we compared risk factors, preoperative ultrasound, and serum hCG le vels between cases with ruptured and unruptured tubal ectopic pregnanc y. Results: The age and the number of pregnancies among the two groups of women were similar. The gestational age of women with an unrupture d tube was 6.9 +/- 1.9 weeks, and of those with a ruptured tube, the g estational age was 7.2 +/- 2.2 weeks. Tubal rupture was encountered mo re often in women with at least one child than in childless women. His tory of ectopic pregnancy was found in 35% of women with an unruptured tubal pregnancy and in 26% of those with a ruptured tube. Serum hCG l evels at the time of treatment were not significantly different among the two groups of women. Eleven percent of women with a ruptured tube had serum beta-hCG levels of less than 100 IU/L. Conclusion: Tubal rup ture is encountered more often in women with no history of ectopic pre gnancy and in those with at least one child. This suggests that ectopi c pregnancy is less suspected in these women. Tubal rupture is encount ered less often in ampullary pregnancy and in small ectopic pregnancie s. There is no correlation between serum beta-hCG levels and-tubal rup ture, and rupture can occur even when serum beta-hCG levels are very l ow. (C) 1997 by The American College of Obstetricians and Gynecologist s.