Asal Darwish, Sharon Avishalom, Inshirah Sgayer, Susana Mustafa Mikhail, Lior Lowenstein, Ala Aiob
{"title":"Distinguishing tubal rupture from tubal abortion in ectopic pregnancies after methotrexate treatment: a retrospective cohort study.","authors":"Asal Darwish, Sharon Avishalom, Inshirah Sgayer, Susana Mustafa Mikhail, Lior Lowenstein, Ala Aiob","doi":"10.1007/s00404-025-08069-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To identify clinical, sonographic, and laboratory characteristics that distinguish between tubal rupture and tubal abortion following methotrexate (MTX) treatment for ectopic pregnancy (EP) and to compare the morbidity associated with these 2 outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included women treated with MTX for EP at Galilee Medical Center between 2012 and 2024. Data on clinical presentation, ultrasound findings, and laboratory values were analyzed. Uregint surgical interventions were classified as tubal rupture or tubal abortion based on intraoperative findings. A comparative analysis between these groups was performed, and multivariable modeling was used to identify predictors of tubal rupture.</p><p><strong>Results: </strong>Among 280 women treated with MTX, 47 (16.7%) required urgent surgical intervention. Of these, 15 (34.9%) were confirmed as tubal rupture, while 28 (65.1%) were tubal abortion. Women with tubal rupture more frequently presented with free pelvic fluid on transvaginal ultrasound (64.3 vs. 28.6%, P = 0.045) and had significantly higher intraoperative blood loss (433 ± 143 mL vs. 250 ± 201 mL, P = 0.001). A multivariable logistic regression model identified free pelvic fluid as an independent predictor of tubal rupture (odds ratio: 6.09, 95% CI 1.23-30.09, P = 0.027). No significant differences in preoperative beta-hCG levels or other clinical symptoms were observed between the groups.</p><p><strong>Conclusion: </strong>Tubal rupture and tubal abortion share overlapping clinical features, making differentiation with current diagnostic tools challenging. Free pelvic fluid on ultrasound is a significant indicator of tubal rupture, underscoring the importance of timely surgical intervention. Recognizing that tubal abortion may be a self-limiting condition in some cases offers opportunities to preserve fallopian tube integrity and reduce unnecessary surgeries. Further research is needed to improve diagnostic accuracy and explore conservative management strategies for tubal abortion. Date and number of trial registration: December 2024, 0138-24-NHR.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Gynecology and Obstetrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00404-025-08069-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To identify clinical, sonographic, and laboratory characteristics that distinguish between tubal rupture and tubal abortion following methotrexate (MTX) treatment for ectopic pregnancy (EP) and to compare the morbidity associated with these 2 outcomes.
Methods: This retrospective cohort study included women treated with MTX for EP at Galilee Medical Center between 2012 and 2024. Data on clinical presentation, ultrasound findings, and laboratory values were analyzed. Uregint surgical interventions were classified as tubal rupture or tubal abortion based on intraoperative findings. A comparative analysis between these groups was performed, and multivariable modeling was used to identify predictors of tubal rupture.
Results: Among 280 women treated with MTX, 47 (16.7%) required urgent surgical intervention. Of these, 15 (34.9%) were confirmed as tubal rupture, while 28 (65.1%) were tubal abortion. Women with tubal rupture more frequently presented with free pelvic fluid on transvaginal ultrasound (64.3 vs. 28.6%, P = 0.045) and had significantly higher intraoperative blood loss (433 ± 143 mL vs. 250 ± 201 mL, P = 0.001). A multivariable logistic regression model identified free pelvic fluid as an independent predictor of tubal rupture (odds ratio: 6.09, 95% CI 1.23-30.09, P = 0.027). No significant differences in preoperative beta-hCG levels or other clinical symptoms were observed between the groups.
Conclusion: Tubal rupture and tubal abortion share overlapping clinical features, making differentiation with current diagnostic tools challenging. Free pelvic fluid on ultrasound is a significant indicator of tubal rupture, underscoring the importance of timely surgical intervention. Recognizing that tubal abortion may be a self-limiting condition in some cases offers opportunities to preserve fallopian tube integrity and reduce unnecessary surgeries. Further research is needed to improve diagnostic accuracy and explore conservative management strategies for tubal abortion. Date and number of trial registration: December 2024, 0138-24-NHR.
目的：鉴别甲氨蝶呤（MTX）治疗异位妊娠（EP）后输卵管破裂和输卵管流产的临床、超声和实验室特征，并比较与这两种结局相关的发病率。方法：这项回顾性队列研究纳入了2012年至2024年间在加利利医疗中心接受MTX治疗EP的女性。对临床表现、超声检查结果和实验室值进行分析。根据术中发现将输卵管破裂或输卵管流产分类为输卵管手术干预。对这些组进行比较分析，并使用多变量模型来确定输卵管破裂的预测因素。结果：在280名接受MTX治疗的女性中，47名（16.7%）需要紧急手术干预。其中输卵管破裂15例（34.9%），输卵管流产28例（65.1%）。输卵管破裂的女性在阴道超声检查中更多地出现游离盆腔液（64.3%比28.6%,P = 0.045），术中出血量明显增加（433±143 mL比250±201 mL， P = 0.001）。多变量logistic回归模型确定游离盆腔液是输卵管破裂的独立预测因子（优势比：6.09,95% CI 1.23-30.09, P = 0.027）。两组术前β - hcg水平及其他临床症状均无显著差异。结论：输卵管破裂和输卵管流产具有重叠的临床特征，使当前诊断工具的鉴别具有挑战性。超声显示游离盆腔液是输卵管破裂的重要指标，强调了及时手术干预的重要性。认识到输卵管流产在某些情况下可能是一种自我限制的情况，为保持输卵管完整性和减少不必要的手术提供了机会。需要进一步的研究来提高诊断的准确性和探索输卵管流产的保守治疗策略。试验注册日期和编号：2024年12月，0138-24-NHR。
期刊介绍：
Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report".
The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
