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.


METHODS
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.


CONCLUSIONS
The success rate of methotrexate therapy for ectopic pregnancy was lower than that of surgical management in a university setting serving an indigent population.
Lewis-Bliehall
C
C
Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
Rogers
R G
RG
Kammerer-Doak
D N
DN
Conway
S C
SC
Amaya
C
C
Byrn
F
F
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D009516:New Mexico; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate