Ectopic pregnancy management and treatment strategies: A nationwide survey of Czech gynecological facilities.

BACKGROUND

Ectopic pregnancy (EP) remains a significant cause of maternal morbidity and mortality, with diverse clinical presentations and substantial variability in treatment strategies.

OBJECTIVES

To assess current EP management approaches across gynecological inpatient departments of all sizes in the Czech Republic.

DESIGN

A nationwide cross-sectional observational questionnaire study.

METHODS

A survey was conducted in January 2025. All 92 registered inpatient gynecological wards in the Czech Republic were invited to participate in an anonymous online questionnaire on EP diagnosis and treatment. A total of 89 departments (96.7%) responded. Facilities were grouped into four categories based on annual hysterectomy volume. Statistical analyses included chi-squared and Fisher's exact tests with adjustments for multiple comparisons.

RESULTS

Methotrexate (MTX) was available in 82.8% of high-volume centers, compared with 48.3% of smaller facilities (p = 0.002). Despite this, 46.1% of institutions reported never using MTX. The use of MTX for all types of EP was significantly more common in larger centers (72.4% versus 45.0%, p = 0.023), although its use for tubal EP remained generally low (18.0%) with no significant difference by center size. Surgical treatment of tubal EP was consistently preferred by 36.0% of facilities, and 38.2% of surgeons occasionally performed salpingotomy. Laparoscopy was the dominant approach for interstitial pregnancies (86.5%), with universal adoption in high-volume centers (p = 0.007). Suction and curettage were most commonly used for cesarean scar (47.2%) and cervical (60.7%) pregnancies, although treatment strategies varied considerably. Observational management was preferred in pregnancy of unknown location with declining human chorionic gonadotropin (hCG) levels (83.2%), while diagnostic laparoscopy was favored when hCG levels plateaued or rose (57.3%).

CONCLUSION

EP management, even within a country with a homogeneous healthcare system, may demonstrate considerable heterogeneity, strongly influenced by institutional size. These findings highlight the need for national guidelines to ensure standardized and evidence-based care.