Potential limiting factors in resident training for laparoscopic management of ectopic pregnancies

To evaluate resident exposure and training in operative laparoscopic management of ectopic pregnancy (EP).

A review and comparison of the profile and management of consecutive series of patients with EP in two different clinical settings.

A university-affiliated obstetrics and gynecology residency program caring for indigent women, and a private, office-based infertility practice.

Fifty-three consecutive patients with EP treated surgically in an infertility practice (group 1) were compared with 68 such women managed in a residency program (group 2).

Evaluation at the time of hospital admission confirmed significantly lower systolic and diastolic blood pressures (mean +/- SD 106.2 +/- 12.2 mm Hg vs 114.8 +/- 9.1 and 61.1 +/- 14.4 mm Hg vs 71.7 +/- 11.8 mm Hg, p <0.05) and hemoglobin (10.9 +/- 2.7 g/dl vs 12.2 +/- 2.2 g/dl, p <0.05), and higher pulse rates (96.1 +/- 12.1 bpm vs 84.0 +/- 7.7 bpm, p <0.01) for groups 2 and 1, respectively. The mean gestational age at diagnosis was greater in group 2 (52.1 +/- 14.8 days) than in group 1 (46.7 +/- 11.1 days, p <0.05). That the overall clinical picture in group 2 was more serious was confirmed by a larger mean gestational mass (4.4 +/- 3.1 cm vs 2.8 +/- 2.6 cm, p <0.01), more frequent rupture (69% vs 21%, p <0.01), and a larger hemoperitoneum (547 +/- 488 ml vs 215 +/- 202 ml, p <0. 05). Similarly, 49% of group 2 patients required postoperative or intraoperative blood transfusion, compared with 13% of group 1 (p <0. 01). Forty-four of 53 women in group 1 were managed laparoscopically (83%), whereas only 16 (24%) in group 2 were so treated (p <0.05).

Patients in group 2 were more hemodynamically compromised, had more advanced gestations, and had more ruptured EPs, leading to decreased opportunities for laparoscopic management. Active resident participation in operative management of nonindigent women with EP may be necessary to ensure appropriate training.