Abstract
Amaç: Bu çalışmanın amacı, ektopik gebeliği (EG) olan kadınlarda tubal rüptür ile ilişkili özgül risk faktörlerini ve klinik özellikleri belirlemek ve analiz etmektir.
Gereç ve Yöntem: 2015–2024 yılları arasında üçüncü basamak bir sağlık merkezinde EG tanısı alan 180 kadın retrospektif olarak incelendi.
Hastalar iki gruba ayrıldı: tubal rüptür gelişenler (n=132) ve rüptür gelişmeyen EG olguları (n=48). Hastaların demografik özellikleri, üreme öyküleri, başvuru sırasındaki klinik bulguları, serum beta-human chorionic gonadotropin (β-hCG) düzeyleri ve cerrahi sonuçları değerlendirildi.
Bulgular: Rüptüre EG olguları anlamlı olarak daha genç (31,2 ± 5,5 vs. 33,3 ± 5,8 yıl; p=0,026) ve ortalama serum β-hCG düzeyleri daha düşüktü (3037,9 ± 4438,5 vs. 5483,6 ± 5300,8 mIU/mL; p=0,006). Önceki EG öyküsü ve tubal cerrahi öyküsü, rüptür gelişmeyen olgularda daha sık saptandı (sırasıyla p=0,018 ve p=0,017). Çok değişkenli lojistik regresyon analizinde; daha genç yaş (düzeltilmiş olasılık oranı [aOR] 0,91; %95 GA, 0,84–0,98; p=0,018), karın ağrısı varlığı (aOR 3,27; %95 GA, 1,06–10,05; p=0,039) ve düşük serum β-hCG düzeyleri (p<0,001) bağımsız rüptür öngördürücüleri olarak doğrulandı. Cerrahi tedavide salpenjektomi, rüptüre olgularda baskın prosedür olarak uygulandı (%97,7), bu oran rüptür gelişmeyenlerde daha düşüktü (%89,6; p=0,006).
Sonuç: Ektopik gebelikte tubal rüptür, bağımsız olarak daha genç yaş, düşük serum β-hCG düzeyleri ve karın ağrısı varlığı ile ilişkili bulundu. Önceki ektopik gebelik öyküsü ise rüptür gelişmeyen olgularda daha sık gözlendi.
Keywords
Ethical Statement
Bu çalışma Helsinki Bildirgesi prensiplerine uygun olarak gerçekleştirildi. Çalışmaya Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu'nun 2024/14/891 sayılı onayı alındı.
Supporting Institution
Yoktur.
Thanks
Yoktur.
References
- Mullany K, Minneci M, Monjazeb R, C Coiado O. Overview of ectopic pregnancy diagnosis, management, and innovation. Womens Health (Lond). 2023;19:17455057231160349.
- Papageorgiou D, Sapantzoglou I, Prokopakis I, Zachariou E. Tubal Ectopic Pregnancy: From Diagnosis to Treatment. Biomedicines. 2025;13(6):1465.
- Faraji Darkhaneh R, Asgharnia M, Farahmand Porkar N, Alipoor AA. Predictive value of maternal serum β-hCG concentration in the ruptured tubal ectopic pregnancy. Iran J Reprod Med. 2015;13(2):101-106.
- Skinner A, Jones P. Negative betahCG: positive ectopic pregnancy. N Z Med J. 2003;116(1183):U630.
- Galstyan K, Kurzel RB. Serum beta-hCG titers do not predict ruptured ectopic pregnancy. Int J Fertil Womens Med. 2006;51(1):14-16.
- Gizaw NT, K/Mariam MA, Fayera MG. Magnitude of ectopic pregnancy, management methods, and its associated factors among pregnant women attending Ambo University Referral Hospital in Oromia Regional State, Ethiopia: A seven years retrospective institutional based cross-sectional study. PLOS Glob Public Health. 2025;5(6):e0004611.
- Roussos D, Panidis D, Matalliotakis I, et al. Factors that may predispose to rupture of tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2000;89(1):15-17.
- National Guideline Alliance (UK). Diagnostic accuracy of ultrasound features for tubal ectopic pregnancy: Ectopic pregnancy and miscarriage: diagnosis and initial management: Evidence review A. London: National Institute for Health and Care Excellence (NICE); 2019 Apr. (NICE Guideline, No. 126.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK576537/
- Harish KM, Shwetha N, Nalini N. Incidence and risk factors associated with ectopic pregnancy: a prospective study. Int J Reprod Contracept Obstet Gynecol. 2021;10(2):703.
- Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. Gynecol Obstet Invest. 2005;60(3):177-180.
- Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011;37(4):231-240. doi: 10.1136/jfprhc-2011-0073.
- Li PC, Lin WY, Ding DC. Risk factors and clinical characteristics associated with a ruptured ectopic pregnancy: A 19-year retrospective observational study. Medicine (Baltimore). 2022;101(24):e29514.
- Xu C, Mao Z, Tan M, et al. Prevalence and Related Factors of Rupture among Cases with Ectopic Pregnancy; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2023;12(1):e2.
- Sindos M, Togia A, Sergentanis TN, et al. Ruptured ectopic pregnancy: risk factors for a life-threatening condition. Arch Gynecol Obstet. 2009;279(5):621-623.
- Saxon D, Falcone T, Mascha EJ, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy. Obstet Gynecol. 1997;90(1):46-49.
Abstract
Aim: This study aimed to identify and analyze the specific risk factors and clinical characteristics associated with tubal rupture in women with ectopic pregnancy (EP).
Materials and Methods: A retrospective analysis was conducted on 180 women diagnosed with EP at a tertiary care center between 2015 and 2024. Patients were stratified into two groups: those with tubal rupture (n=132) and those with unruptured EP (n=48). Patient demographics, reproductive history, presenting clinical signs, serum beta-human chorionic gonadotropin (β-hCG) levels, and operative outcomes were collected.
Results: Women with ruptured EP were significantly younger (31.2 ± 5.5 vs. 33.3 ± 5.8 years; p = 0.026) and presented with significantly lower mean serum β-hCG concentrations (3037.9 ± 4438.5 vs. 5483.6 ± 5300.8 mIU/mL; p = 0.006). A history of a prior EP and tubal surgery was more frequent among unruptured cases (p = 0.018 and p = 0.017, respectively). In multivariable logistic regression, younger age (adjusted odds ratio [aOR] 0.91; 95% CI, 0.84–0.98; p = 0.018), the presence of abdominal pain (aOR 3.27; 95% CI, 1.06–10.05; p = 0.039), and lower serum β-hCG (p <0.001) were confirmed as independent predictors of rupture. Salpingectomy was the predominant surgical procedure in ruptured cases (97.7%) compared to unruptured cases (89.6%; p = 0.006).
Conclusion: Tubal rupture in EP was independently associated with younger age, lower serum β-hCG levels, and the presence of abdominal pain. A history of EP was observed more frequently among unruptured cases
Ethical Statement
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Research Ethics Committee of University of Health Sciences, Kartal Kosuyolu Training And Research Hospital Clinical Research Ethics Committee (number: 2024/14/891).
Supporting Institution
None.
Thanks
None.
References
- Mullany K, Minneci M, Monjazeb R, C Coiado O. Overview of ectopic pregnancy diagnosis, management, and innovation. Womens Health (Lond). 2023;19:17455057231160349.
- Papageorgiou D, Sapantzoglou I, Prokopakis I, Zachariou E. Tubal Ectopic Pregnancy: From Diagnosis to Treatment. Biomedicines. 2025;13(6):1465.
- Faraji Darkhaneh R, Asgharnia M, Farahmand Porkar N, Alipoor AA. Predictive value of maternal serum β-hCG concentration in the ruptured tubal ectopic pregnancy. Iran J Reprod Med. 2015;13(2):101-106.
- Skinner A, Jones P. Negative betahCG: positive ectopic pregnancy. N Z Med J. 2003;116(1183):U630.
- Galstyan K, Kurzel RB. Serum beta-hCG titers do not predict ruptured ectopic pregnancy. Int J Fertil Womens Med. 2006;51(1):14-16.
- Gizaw NT, K/Mariam MA, Fayera MG. Magnitude of ectopic pregnancy, management methods, and its associated factors among pregnant women attending Ambo University Referral Hospital in Oromia Regional State, Ethiopia: A seven years retrospective institutional based cross-sectional study. PLOS Glob Public Health. 2025;5(6):e0004611.
- Roussos D, Panidis D, Matalliotakis I, et al. Factors that may predispose to rupture of tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2000;89(1):15-17.
- National Guideline Alliance (UK). Diagnostic accuracy of ultrasound features for tubal ectopic pregnancy: Ectopic pregnancy and miscarriage: diagnosis and initial management: Evidence review A. London: National Institute for Health and Care Excellence (NICE); 2019 Apr. (NICE Guideline, No. 126.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK576537/
- Harish KM, Shwetha N, Nalini N. Incidence and risk factors associated with ectopic pregnancy: a prospective study. Int J Reprod Contracept Obstet Gynecol. 2021;10(2):703.
- Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. Gynecol Obstet Invest. 2005;60(3):177-180.
- Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011;37(4):231-240. doi: 10.1136/jfprhc-2011-0073.
- Li PC, Lin WY, Ding DC. Risk factors and clinical characteristics associated with a ruptured ectopic pregnancy: A 19-year retrospective observational study. Medicine (Baltimore). 2022;101(24):e29514.
- Xu C, Mao Z, Tan M, et al. Prevalence and Related Factors of Rupture among Cases with Ectopic Pregnancy; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2023;12(1):e2.
- Sindos M, Togia A, Sergentanis TN, et al. Ruptured ectopic pregnancy: risk factors for a life-threatening condition. Arch Gynecol Obstet. 2009;279(5):621-623.
- Saxon D, Falcone T, Mascha EJ, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy. Obstet Gynecol. 1997;90(1):46-49.
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Article |
| Authors | |
| Submission Date | September 18, 2025 |
| Acceptance Date | October 28, 2025 |
| Publication Date | March 9, 2026 |
| DOI | https://doi.org/10.19161/etd.1786283 |
| IZ | https://izlik.org/JA69MK93WZ |
| Published in Issue | Year 2026 Volume: 65 Issue: 1 |
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