Management strategies and outcomes of non-tubal ectopic pregnancies: a single-center cohort study
Diana Toro1, Nicholas Stansbury2, Katherine Kostroun2
1Department of Obstetrics and Gynecology, University of Texas Health San Antonio, TX, USA.
Research Question:
How do the presentation, management strategies, and clinical outcomes of patients with non-tubal ectopic pregnancies differ in a single-center cohort study, and is there an association between initial serum β-hCG level and time-to-resolution?
Study Design:
We conducted a retrospective chart review of patients diagnosed with NTEPs at a single academic medical center between 2015 and 2024. Demographic, imaging, treatment, and outcome data were abstracted from REDCap. Treatments were categorized into medical (systemic methotrexate), local intragestational therapy, hybrid intragestational plus systemic therapy, surgical management, interventional radiology, or expectant management. The primary outcome was time-to-resolution of serum β-hCG. Secondary analyses evaluated outcomes by treatment category. Spearman rank correlation assessed the association between initial β-hCG and time-to-resolution; Kruskal-Wallis testing compared initial β-hCG across treatment strategies. Treatment selection was additionally evaluated according to implantation site. Outcomes were classified into three tiers: confirmed completion of the initial strategy, documented unplanned treatment escalation, or indeterminate outcome because of incomplete follow-up.
Results:
Complete time-to-biochemical-resolution data were available for 36 of 67 patients. Higher initial β-hCG was associated with a longer time to resolution in the complete-case analysis. Treatment differed by implantation site: surgical/operative management was used in 9 of 20 interstitial/cornual pregnancies (45.0%), compared with 7 of 33 cesarean-scar pregnancies (21.2%) and 1 of 14 cervical pregnancies (7.1%). Overall, 40 patients (59.7%) had confirmed completion of the initial strategy, 11 (16.4%) had documented unplanned treatment escalation, and 16 (23.9%) had an indeterminate outcome because of incomplete follow-up.
Conclusions:
Management of non-tubal ectopic pregnancies varied by implantation site and clinical presentation. Among patients with complete biochemical-resolution data, higher initial β-hCG was associated with a longer time to resolution. Eleven patients experienced documented unplanned treatment escalation, underscoring the importance of distinguishing escalation from planned multimodal therapy and explicitly accounting for incomplete follow-up. Because treatment selection was individualized and nonrandom, these findings do not identify a single superior management strategy but provide clinically relevant site-specific management and outcome data.
