Prevalence and Related Factors of Rupture among Cases with Ectopic Pregnancy; a Systematic Review and Meta-Analysis

Chenchen Xu; Zhilei Mao; Mi Tan; Seyed Amirhossein Mazhari; Pooyan Ghorbani Vajargah; Samad Karkhah; Fatemeh Izadi; Parisa Rouhi

doi:10.22037/aaem.v11i1.2172

Prevalence and Related Factors of Rupture among Cases with Ectopic Pregnancy; a Systematic Review and Meta-Analysis

Arch Acad Emerg Med. 2023 Nov 2;12(1):e2. doi: 10.22037/aaem.v11i1.2172. eCollection 2024.

Authors

Chenchen Xu¹, Zhilei Mao¹, Mi Tan¹, Seyed Amirhossein Mazhari², Pooyan Ghorbani Vajargah³, Samad Karkhah³, Fatemeh Izadi⁴, Parisa Rouhi⁵

Affiliations

¹ Department of gynecology and obstetrics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000 China.
² Student Research Committee, Azerbaijan Medical University, Baku, Azerbaijan.
³ Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
⁴ Department of Nursing, School of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
⁵ Student Research Committee, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

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.

Keywords: Ectopic pregnancies; Extrauterine pregnancies; Meta‐analysis; Ruptured ectopic pregnancy.

Publication types

Review