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

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Abstract
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.
Funding Information
  • Ministerstvo Zdravotnictví Ceské Republiky (NW24-09-00505)
  • Univerzita Karlova v Praze (Cooperatio program, Maternal and Childhood Care No)

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