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

Summary

This retrospective study analyzed 150 patients with tubal pregnancy to identify predictors of tubal rupture. A history of pelvic inflammatory disease (PID), serum human chorionic gonadotropin (β-hCG) > 3,000 IU/L, neutrophil-to-lymphocyte ratio (NLR) ≥ 4, and ultrasonographic detection of a yolk sac were independent risk factors.

Abstract

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.

Introduction

Ectopic pregnancy refers to the implantation and development of a fertilized ovum outside the uterine cavity, with approximately 95% occurring in the fallopian tubes¹. Ectopic pregnancy is a common cause of acute abdominal emergencies in obstetrics and gynecology, with an incidence of approximately 1%–2% among women of reproductive age². Despite the widespread use of high-resolution transvaginal ultrasound (TVUS) and dynamic monitoring of serum human chorionic gonadotropin (β-hCG) in recent years, which have enabled early diagnosis and conservative treatment (such as methotrexate or expectant treatment) for mo....

Protocol

The study protocol was approved by the Ethics Committee of Jinhua Municipal Central Hospital (2026, Ethics approval No.277). Because of the retrospective study design, the requirement for informed consent was waived. Data collection and retrospective analysis were conducted in accordance with the Declaration of Helsinki¹⁷. The study used deidentified medical records and involved no direct contact with participants.

Research subjects
Patient identification and screening
This retrospective study reviewed the hospital electronic medical record system for records cod....

Results

Baseline characteristics
This study included 150 patients with tubal pregnancy, including 51 (34.0%) in the ruptured group and 99 (66.0%) in the unruptured group. As shown in Table 1, there were no statistically significant differences between groups in age, BMI, number of pregnancies, parity, duration of amenorrhea, history of ectopic pregnancy, history of pelvic or abdominal surgery, use of assisted reproductive technology, or smoking (P > 0.05). However, the proportion of patie.......

Discussion

Multivariable analysis in this study showed that serum β-hCG > 3,000 IU/L is an independent risk factor for rupture of tubal pregnancy. β-hCG is secreted by embryonic syncytiotrophoblasts, and its serum concentration may reflect the proliferation activity and metabolic level of trophoblasts²⁴. In a normal intrauterine pregnancy, the endometrium undergoes sufficient decidualization reaction, forming physical and immune barriers to limit the excessive invasion of trophoblasts. However,.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Automated hematology analyzer	Sysmex Corporation, Kobe, Japan	XN-9000	Used for complete blood count measurements
Electrochemiluminescence immunoassay analyzer	Roche Diagnostics, Mannheim, Germany	Cobas e601	Used for serum β-hCG and progesterone measurements
K2-EDTA vacuum blood collection tube	Becton Dickinson, Franklin Lakes, NJ, USA	Vacutainer K2-EDTA	Used for complete blood count collection
Sample size calculation software	Heinrich Heine University, Düsseldorf, Germany	G*Power, version 3.1.9.7; RRID: SCR_013726	Used for sample size estimation
Serum separator tube	Becton Dickinson, Franklin Lakes, NJ, USA	Vacutainer SST	Used for serum β-hCG and progesterone collection
Statistical software	IBM Corp., Armonk, NY, USA	SPSS Statistics, version 25.0; RRID: SCR_002865	Used for statistical analyses
Ultrasound system	GE Healthcare, Milwaukee, WI, USA	Voluson E8	Equipped with RIC5-9-D transvaginal probe (5-9 MHz) and C1-5-D transabdominal convex probe (3.5-5 MHz)