Distinguishing tubal rupture from tubal abortion in ectopic pregnancies after methotrexate treatment: a retrospective cohort study

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.