POTENTIAL LIMITING FACTORS IN RESIDENT TRAINING FOR LAPAROSCOPIC MANAGEMENT OF ECTOPIC PREGNANCIES

Study Objective. To evaluate resident exposure and training in operati ve laparoscopic management of ectopic pregnancy (EP). Design. A review and comparison of the profile and management of consecutive series of patients with EP in two different clinical settings. Setting. A unive rsity-affiliated obstetrics and gynecology residency program caring fo r indigent women, and a private, office-based infertility practice. Pa tients. Fifty-three consecutive patients with EP treated surgically in an infertility practice (group 1) were compared with 68 such women ma naged in a residency program (group 2). Results. Evaluation al the tim e of hospital admission confirmed significantly lower systolic and dia stolic blood pressures (mean +/- SD 106.2 +/- 12.2 mm Hg vs 114.8 +/- 9.1 and 61.1 +/- 14.4 mm Hg vs 71.7 +/- 11.8 mm Hg, p < 0.05) and hemo globin (10.9 +/- 2.7 g/dl vs 12.2 +/- 2.2 g/dl, p < 0.05), and higher pulse rates (96.1 +/- 12.1 bpm vs 84.0 +/- 7.7 bpm, p < 0.01) for grou ps 2 and 1, respectively. The mean gestational age at diagnosis was gr eater in group 2 (52.1 +/- 14.8 days) than in group 1 (46.7 +/- 11.1 d ays, p < 0.05). That the overall clinical picture in group 2 was more serious was confirmed by a larger mean gestational mass (4.4 +/- 3.1 c m vs 2.8 +/- 2.6 cm, p < 0.01), more frequent rupture (69% vs 21%, p < 0.01), and a larger hemoperitoneum (547 +/- 488 mi vs 215 +/- 202 ml, p < 0.05). Similarly, 49% of group 2 patients required postoperative or intraoperative blood transfusion, compared with 13% of group 1 (p < 0.01). Forty-four of 53 women in group 1 were managed laparoscopicall y (83%), whereas only 16 (24%) in group 2 were so treated (p < 0.05). Conclusion. Patients in group 2 were more hemodynamically compromised, had more advanced gestations, and had more ruptured EPs, leading to d ecreased opportunities for laparoscopic management. Active resident pa rticipation in operative management of nonindigent women with EP may b e necessary to ensure appropriate training.