Prevalence and Related Factors of Rupture among Cases with Ectopic Pregnancy; a Systematic Review and Meta‐Analysis
Archives of Academic Emergency Medicine,
Vol. 12 No. 1 (2024),
1 January 2024
,
Page e2
https://doi.org/10.22037/aaem.v12i1.2172
Abstract
Introduction: In the absence of timely treatment, the risk of rupture in patients with ectopic pregnancy (EP) increases, which is associated with extensive bleeding, complicated surgery, and maternal death. This study aimed to investigate the prevalence of rupture and its related factors among EP cases.
Methods: A comprehensive, systematic search was conducted in electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Ectopic pregnancies", "Extrauterine pregnancies", and "Ruptured ectopic pregnancy" from the earliest to the 13th of December 2022. The CMA program, version 3, was utilized for analysis. The overall effect size was calculated using the sample size and the frequency of rupture in each of the studies. Heterogeneity was measured using the I2 statistics.
Results: A total of 5,269 women with EP participated in 17 studies. The pooled prevalence of rupture was 56.4% (95%CI: 44.9% to 67.2%; I2=98.09%; P<0.001). Factors such as number of parties, amount of β-hCG, age, history of ectopic pregnancy, cornual and isthmic pregnancies, gestational age, number of gravidities, history of tubal ligation, tubal diameters, periods of infertility, history of infertility, pregnancy by ovulation induction, extensive hemoperitoneum, ampullar and isthmic pregnancies, ampullar pregnancies, preoperative heart rate (HR), triage, triage shock index (SI), abdominal pain, single marital status, preoperative hemoglobin levels, preoperative hematocrit levels, history of pelvic inflammatory disease (PID), and use of contraceptives were associated with the prevalence of rupture in EP cases.
Conclusion: Based on the findings, 56.4% of EP cases experienced rupture and various factors influence its prevalence. As a result, health managers and policymakers can address and mitigate modifiable factors contributing to rupture in EP cases by implementing regular consultations and screenings.
- Ectopic pregnancies
- Extrauterine pregnancies
- Ruptured ectopic pregnancy
- Meta‐analysis
How to Cite
References
Jin X-Y, Li C, Xu W, Liu L, Wei M-L, Fei H-Y, et al. Factors associated with the incidence of ectopic pregnancy in women undergoing assisted reproductive treatment. Chinese Medical Journal. 2020;133(17):2054-60.
Marion LL, Meeks GR. Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clinical obstetrics and gynecology. 2012;55(2):376-86.
Sefogah PE, Oduro NE, Swarray-Deen A, Nuamah HG, Takyi RB, Nuamah MA, et al. Factors Associated with Ruptured Ectopic Pregnancy: A 10-Year Review at a District Hospital in Ghana. Obstetrics and Gynecology International. 2022;2022.
Tsakiridis I, Giouleka S, Mamopoulos A, Athanasiadis A, Dagklis T. Diagnosis and management of ectopic pregnancy: A comparative review of major national guidelines. Obstetrical & Gynecological Survey. 2020;75(10):611-23.
Gerema U, Alemayehu T, Chane G, Desta D, Diriba A. Determinants of ectopic pregnancy among pregnant women attending referral hospitals in southwestern part of Oromia regional state, Southwest Ethiopia: a multi-center case control study. BMC pregnancy and childbirth. 2021;21(1):1-8.
Mann LM, Kreisel K, Llata E, Hong J, Torrone EA. Trends in ectopic pregnancy diagnoses in United States emergency departments, 2006–2013. Maternal and child health journal. 2020;24(2):213-21.
Wakankar R, Kedar K. Ectopic pregnancy-a rising trend. International Journal of Scientific Study. 2015;3(5):18-22.
Dabota BY. Management and outcome of ectopic pregnancy in developing countries. Ectopic Pregnancy: Modern Diagnosis and Management. 2011:109.
Stabile G, Zinicola G, Romano F, Buonomo F, Mangino FP, Ricci G. Management of non-tubal ectopic pregnancies: a single center experience. Diagnostics. 2020;10(9):652.
Lee R, Dupuis C, Chen B, Smith A, Kim YH. Diagnosing ectopic pregnancy in the emergency setting. Ultrasonography. 2018;37(1):78.
Bai M, Kulsoom O, Azra B, Atta J, Javaid S. Incidence, Predictability and Causes of Tubal Rupture IN Ectopic Pregnancy in a Pakistani Population: A Descriptive Cross-Sectional Study. Journal of Research in Medical and Dental Science. 2022;10(1):110-5.
Mummert T, Gnugnoli D. Ectopic Pregnancy [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [updated 8 Aug 2022.
Dvash S, Cuckle H, Smorgick N, Vaknin Z, Padoa A, Maymon R. Increase rate of ruptured tubal ectopic pregnancy during the COVID-19 pandemic. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021;259:95-9.
Dialani V, Levine D. Ectopic pregnancy: a review. Ultrasound quarterly. 2004;20(3):105-17.
Rana P, Kazmi I, Singh R, Afzal M, Al-Abbasi FA, Aseeri A, et al. Ectopic pregnancy: a review. Archives of gynecology and obstetrics. 2013;288(4):747-57.
Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. Journal of family planning and reproductive health care. 2011;37(4):231-40.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372.
Corlett RT. Trouble with the gray literature. Biotropica. 2011;43(1):3-5.
Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ open. 2016;6(12):e011458.
Ali A, Abdallah TM, Siddig MF. Diagnosis of ruptured ectopic pregnancy is still a challenge in Eastern Sudan. African Journal of Reproductive Health. 2011;15(4):106-8.
Anaswara T, Sheelamoni A, Thomas S. A comparison between ruptured and unruptured ectopic pregnancy and its association with the risk factors: A single-center study. International Journal of Clinical Obstetrics and Gynaecology. 2021;5:79-84.
Ashfaq S, Sultan S, Aziz S, Irfan SM, Hasan M, Siddique A. Ectopic pregnancy with tubal rupture: an analysis of 80 cases. Journal of Ayub Medical College Abbottabad. 2017;29(2):254-7.
Berlingieri P, Bogdanskiene G, Grudzinskas JG. Rupture of tubal pregnancy in the Vilnius population. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2007;131(1):85-8.
Birkhahn RH, Gaeta TJ, Van Deusen SK, Tloczkowski J. The ability of traditional vital signs and shock index to identify ruptured ectopic pregnancy. American journal of obstetrics and gynecology. 2003;189(5):1293-6.
Darkhaneh RF, Asgharnia M, Porkar NF, Alipoor AA. Predictive value of maternal serum β-hCG concentration in the ruptured tubal ectopic pregnancy. Iranian journal of reproductive medicine. 2015;13(2):101.
Falcone T, Mascha EJ, Goldberg JM, Falconi LL, Mohla G, Attaran M. A study of risk factors for ruptured tubal ectopic pregnancy. Journal of Women's Health. 1998;7(4):459-63.
Faraji R, Milani F, Dalil Heirati S, Hossaini S. A survey of the frequency of ruptured ectopic pregnancy and its risk factors at Alzahra hospital of Rasht during 2001-2006. Iranian Journal of Surgery. 2013;21(2).
Goksedef BPC, Kef S, Akca A, Bayik RNE, Cetin A. Risk factors for rupture in tubal ectopic pregnancy: definition of the clinical findings. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2011;154(1):96-9.
Job-Spira N, Fernandez H, Bouyer J, Pouly J-L, Germain E, Coste J. Ruptured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France. American journal of obstetrics and gynecology. 1999;180(4):938-44.
Kaya C, Cengiz H, Ekin M, Karakas S, Yasar L. β-Human chorionic gonadotropin in prediction of tubal rupture. Is it enough in the diagnosis? Gineco Eu. 2013;9:174-7.
Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. Gynecologic and obstetric investigation. 2005;60(3):177-80.
Li P-C, Lin W-Y, Ding D-C. Risk factors and clinical characteristics associated with a ruptured ectopic pregnancy: A 19-year retrospective observational study. Medicine. 2022;101(24):e29514-e.
Saxon D, Falcone T, Mascha EJ, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy. Obstetrics & Gynecology. 1997;90(1):46-9.
Sindos M, Togia A, Sergentanis TN, Kabagiannis A, Malamas F, Farfaras A, et al. Ruptured ectopic pregnancy: risk factors for a life-threatening condition. Archives of Gynecology and Obstetrics. 2009;279(5):621-3.
Khalil N, Pervin R, Halim KS, Islam SM, Ansary SA, Masuduzzaman SM. Pattern of Ruptured Ectopic Pregnancy in a Secondary Level Healthcare Facility. Bangladesh Medical Journal. 2019;48(2):20-3.
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.
Ayenew A. Prevalence and determinants of ectopic pregnancy in Ethiopia: Systematic review and meta-analysis. Journal of Endometriosis and Pelvic Pain Disorders. 2022:22840265211062010.
Hinterleitner L, Kiss H. The impact of Cesarean section on female fertility: a narrative review. 2021.
Organization WH. BASIC EMERGENCY CARE: approach to the acutely ill and injured: World Health Organization; 2018.
Kong F, Li Y, Liu X. Effect and clinical value of coagulation test on adverse reactions of blood transfusion in patients with major bleeding in ectopic pregnancy. Experimental and Therapeutic Medicine. 2018;16(6):4712-6.
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