medical vs surgical management of ectopic pregnancy?

Abstract

Objective: To review and compare the treatments for ectopic pregnancy in a university setting serving an indigent population.

Study design: Charts assigned an ICD-9 code for ectopic pregnancy from January 1, 1993, through December 31, 1998, were reviewed for presenting symptoms, hCG levels, ultrasound findings, treatment modality and need for subsequent treatment.

Results: Of 401 patients treated for ectopic pregnancy, 7 were managed expectantly. One hundred nineteen (30%) patients received methotrexate. Seventy percent (83/119) of these ectopic pregnancies resolved with a single dose and an additional 11 after a second dose, for a 79% overall success rate. Twenty-five patients (21%) failed methotrexate therapy and required surgical treatment, and 11 (9%) pregnancies were ruptured. Primary treatment was surgical in 275 (69%) patients: 172 (63%) underwent laparoscopy and 103 (37%) laparotomy. Primary laparoscopic treatment was successful in 90%. Success rates were significantly lower for medical therapy as compared to laparoscopic treatment (79% vs. 90%, odds ratio 2.2, 95% confidence interval 1.1, 4.3; P = .02). No discriminating predictors of successful treatment with methotrexate were identified.

Conclusion: The success rate of methotrexate therapy for ectopic pregnancy was lower than that of surgical management in a university setting serving an indigent population.