Medical vs. surgical treatment of ectopic pregnancy - The University of New Mexico's six-year experience

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 Janu ary 1, 1993, through December 31, 1998, were reviewed for presenting sympto ms, hCG levels, ultrasound findings, treatment modality and need for subseq uent treatment. Results: Of 401 patients treated for ectopic pregnancy, 7 were managed expe ctantly. 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. T wenty-five patients (21%) failed methotrexate therapy and required surgical treatment, and 11 (9%) pregnancies were ruptured. Primary treatment was su rgical in 275 (69%) patients; 172 (63%) underwent laparoscopy and 103 (37%) laparotomy. Primary laparoscopic treatment was successful in 90%. Success were significantly lower for medical therapy as compared to laparoscopic tr eatment (79% vs. 90%, odds ratio 2.2, 95% confidence interval 1.1, 4.3; P=. 02). No discriminating predictors of successful treatments with methotrexat e 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.