Study Indicates Individualized Approach Best for Ectopic Pregnancy: Surgery or Methotrexate?

When facing a patient with ectopic pregnancy, which treatment pathway maximizes success and minimizes risk? A large new study from India's tertiary care system compares laparoscopic surgery and methotrexate-based medical management-revealing important insights for clinical decision-making.

Study Design: Large, Real-World Comparative Analysis

Researchers retrospectively analyzed 650 women with ectopic pregnancy treated at a tertiary care center between January 2024 and December 2025. Patients underwent either laparoscopic surgery (n=390) or medical management with methotrexate (n=260), with treatment selection based on clinical indications. Outcomes included treatment success, need for further intervention, complications, blood transfusion, and hospital stay.

Key Findings: Success, Complications, and Hospital Stay

Laparoscopic surgery had a higher unadjusted treatment success rate (96.4%) compared to medical management (84.2%).

Methotrexate therapy led to a significantly shorter hospital stay (2.7 vs. 4.8 days, p<0.001).

Patients selected for surgery had higher serum β-hCG levels and more severe symptoms—reflecting greater disease severity at baseline.

Additional interventions were more common in the medical group (15.8% vs. 3.6%).

Blood transfusion was required in 22.3% of surgical vs. 4.2% of medically managed patients, related to higher rates of rupture and hemorrhage among surgical cases.

Overall complication rates were comparable between groups.

Individualized Care: The Critical Role of Patient Selection

The study highlights that treatment allocation was not randomized—patients with more severe or ruptured ectopic pregnancies, higher β-hCG, or hemodynamic instability were directed to surgery. Stable patients with lower β-hCG and unruptured ectopic pregnancies were considered for methotrexate.

Multivariate analysis confirmed that laparoscopic surgery remained independently associated with greater odds of treatment success (adjusted OR 3.42), even after controlling for confounders. However, higher β-hCG levels, hemodynamic instability, and rupture all predicted lower odds of success, regardless of treatment.

Implications for Clinical Practice

Laparoscopic surgery is highly effective and definitive, especially for unstable or advanced cases, but comes with a longer hospital stay and higher transfusion needs.

Methotrexate is less invasive and enables shorter hospitalization, but requires strict patient selection, close monitoring, and may need rescue intervention if therapy fails.

The ampullary region was the most common site, and pelvic inflammatory disease the leading risk factor—consistent with global trends.

Conclusion: Match the Modality to the Patient

Both laparoscopic surgery and methotrexate can be effective for ectopic pregnancy—but success depends on individualizing treatment based on severity, β-hCG, ultrasound findings, and patient stability. Surgical intervention remains the gold standard for high-risk patients, while medical management is appropriate for carefully selected, stable cases.

Key points

Laparoscopic surgery had higher unadjusted success rates than methotrexate in this large tertiary care study.

Medical management offered a shorter hospital stay but more often needed additional intervention.

Higher β-hCG, hemodynamic instability, and rupture decreased the likelihood of treatment success—regardless of modality.

Ampullary pregnancies and pelvic inflammatory disease were most common.

Patient selection, early diagnosis, and close follow-up are critical for optimizing outcomes.

Citation:

Apeksha Mohite, Archana Ashtekar, Seeta Devi. Evaluation of laparoscopic surgery and medical management in ectopic pregnancy: experience from a tertiary healthcare center. BMC Pregnancy and Childbirth. 2026; [In Press]. https://doi.org/10.1186/s12884-026-09994-2