Management of ectopic pregnancy at a military medical center

Objective: Advances in laparoscopic surgical techniques and ultrasound technology along with the popularization of treatment with methotrexate have revolutionized accepted algorithms for treating ectopic pregnancy. I analyzed the management of ectopic pregnancy at a military medical center. Methods: A retrospective chart review of ectopic pregnancies at Womack Army Medical Center between January 1997 and July 1999 was conducted. Results: A total of 129 cases of ectopic pregnancy were found. Of those, 77 patients received primary surgical management, 51 patients received primary therapy with methotrexate, and 1 patient was managed expectantly. Eleven patients failed methotrexate therapy and went on to surgical therapy. Of the 88 patients ultimately treated surgically, 76 underwent laparoscopic procedures, 12 received laparotomy, and 11 more converted from laparoscopy to laparotomy. Conclusion: The advent of methotrexate therapy has greatly facilitated the treatment of ectopic pregnancy and altered our institutional algorithm; however, primary surgery is still used more often.