Clinical Management and Outcomes of Ectopic Pregnancies: Experience From Sohar Hospital Over Three Years

TL;DR

This study examines the treatment and outcomes of ectopic pregnancies at a hospital in Oman, finding that surgical management is more effective than medical treatment.

Contribution

The study provides real-world evidence on the efficacy of surgical versus medical treatment for ectopic pregnancies in a specific geographic and clinical setting.

Findings

Surgical management showed a higher success rate (97.6%) compared to medical treatment (85.9%).

Hemodynamic instability independently predicted surgical intervention.

Medical treatment required more additional interventions compared to surgery.

Abstract

Background

Ectopic pregnancy is a potentially life-threatening condition requiring timely diagnosis and appropriate management. This study aims to evaluate the clinical presentation, management strategies, and treatment outcomes of women with ectopic pregnancy at a tertiary care hospital in Oman over a three-year period.

Materials and methods

We retrospectively reviewed 404 ectopic pregnancy cases from 2020 to 2022. Patients received methotrexate or surgical treatment. Patients were evaluated for success rate, complications, hospital stay, and need for further intervention using t-tests, chi-square, and multivariate models.

Results

No significant differences were found between groups regarding age, gravidity, parity, prior ectopic pregnancy, pelvic inflammatory disease, or pelvic surgery. Clinical presentations were similar, though hemodynamic instability was more frequent in the surgical group (15.3% vs. 6.4%, p = 0.01), independently predicting surgical intervention (adjusted odds ratio (AOR) = 2.65, 95% CI: 1.22-5.75). Surgical management yielded a higher success rate (97.6% vs. 85.9%, p < 0.001; AOR = 4.85, 95% CI: 2.01-11.7). Laparoscopy was the predominant surgical method (79.8%), while 28.8% of medically treated patients received multidose methotrexate. Complication rates were comparable (7.7% vs. 7.3%, p = 0.88), but hospital stay was longer in the surgical group (4.8 vs. 2.4 days, p < 0.001). Additional interventions were more common in the medical group (5.1% vs. 0.8%, p = 0.016; AOR = 6.78, 95% CI: 1.35-33.9). Tubal ectopic pregnancies predominated (81.2%), with treatment modality significantly associated with ectopic site (p = 0.0239). Management type was significantly linked to treatment outcome (χ² = 14.5, p < 0.001).

Conclusion

Surgical management demonstrates higher efficacy and reduced need for retreatment, particularly in hemodynamically unstable or non-tubal ectopic pregnancies. Treatment decisions should be guided by clinical stability and anatomical site to optimize outcomes.

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