Time and the risk of ruptured tubal pregnancy.
OBJECTIVE
Tubal pregnancy remains an important cause of maternal morbidity and mortality. We sought to quantify the relationship of time between symptom onset and treatment and the risk of tubal rupture.


METHODS
We reviewed inpatient, clinic, and physician office charts of 221 women with tubal pregnancy. We assessed the conditional risk of rupture with passing time and other factors related to rupture.


RESULTS
Time between symptom onset and treatment varied from 3 hours to 66 days with an average of 7 days. There was a 32% rupture rate. The conditional risk of rupture was highest within the first 48 hours of symptom onset (5-7%). The risk dropped, leveled off, and remained fairly steady at approximately 2.5% per 24 hours of untreated symptoms. Classic tubal pregnancy signs, symptoms, and tests were not helpful in predicting rupture.


CONCLUSIONS
The rate of rupture is highest in women with the shortest times between symptom onset and treatment. With passing time, the risk declines, but remains steady despite women's getting into care.


METHODS
II-2
Department of Health Policy, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York 10029, USA. Nina.Bickell@mssm.edu
Nina A
NA
Bickell
Carol
C
Bodian
Rebecca M
RM
Anderson
Nathan
N
Kase
D000293:Adolescent; D000328:Adult; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000150:complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014597:Uterine Rupture / Q000453:epidemiology* / Q000209:etiology