Time and the risk of ruptured tubal pregnancy

Abstract

OBJECTIVES: Tubal pregnancy remains an important cause of maternal morbidity and mortality. "We sought to quantify the relationship between onset of symptoms, period of amenorrohoea, site of ectopic pregnancy and risk of tubal rupture. METHODS: A retrospective analysis of in-patient records (bed head tickets) of 83 mothers presented to the Gynaecology Department of the THP during 2003 and 2004 were carried out. The risk of tubal rupture with time and other related factors were assessed and analysed. RESULTS: Time between onset of symptoms and treatment varied from 7 hours to 1080 hours (45 days) with a mean 125 hours (5days). Overall 76% of women experienced tubal rupture (n=63). There was one death reported in 2004. The mean time between onset of symptoms and treatment in two groups (ruptured and not ruptured) varied 1 lOhrs to 173hrs and showed statistically significant difference in two groups (p = 0.017, 95% CI - -163.6 to 37.72). The study did not show statistically difference in mean period of amenorrhoea at presentation 44 and 45 days in two groups (p - 0.851 95% CI- -11.72 to-9.32). There was no statistically difference in mean age (29.8, 29.4 years) in two group (p- 0.793, 95%CI — -3.3 to -3.0).Our study did not observe statistically significant association between the site of tubal ectopic and the rupture (p=0.932) Discussion: Despite advances in the diagnosis and treatment of tubal pregnancy, rupture remains a significant problem. Our study confirmed that the time between onset of symptoms and treatment is an important risk factor for rupture. However, there is a wide range in the time between symptom onset and treatment, yet there .were women who experienced nearly one and half month of symptoms and did not go on to rupture. Therefore we recommend early confirmation of site of pregnancy with transvaginal ultra sound scan.