Evaluation of laparoscopic surgery and medical management in ectopic pregnancy: experience from a tertiary healthcare center

Ectopic pregnancy is a major gynecological emergency and an important cause of maternal morbidity during the first trimester of pregnancy. Early diagnosis and appropriate treatment are essential to reduce complications and preserve fertility. Laparoscopic surgery and methotrexate-based medical management are the two principal treatment modalities for appropriately selected patients. To compare the clinical outcomes of laparoscopic surgery and medical management in women with ectopic pregnancy treated at a tertiary healthcare center. A retrospective observational comparative study was conducted at a tertiary healthcare center in Pune, India, including 650 women diagnosed with ectopic pregnancy between January 2024 and December 2025. Patients were managed either by laparoscopic surgery ( n = 390) or medical management with methotrexate ( n = 260) based on clinical indications. Demographic characteristics, clinical presentation, risk factors, serum β-human chorionic gonadotropin (β-hCG) levels, treatment outcomes, complications, and duration of hospital stay were analyzed using IBM SPSS Statistics version 26.0. Continuous variables were compared using the independent t -test, and categorical variables using the Chi-square or Fisher’s exact test. A p -value < 0.05 was considered statistically significant. The majority of patients were 26–30 years old (38.3%). Abdominal pain (92.3%) and amenorrhea (91.8%) were the most common presenting symptoms. Pelvic inflammatory disease (25.8%) was the most frequent identifiable risk factor, and ampullary pregnancy (57.1%) was the predominant implantation site. In the unadjusted analysis, laparoscopic surgery demonstrated a higher treatment success rate than medical management (96.4% vs. 84.2%; p < 0.001) and required fewer additional interventions (3.6% vs. 15.8%; p < 0.001). Medical management was associated with a significantly shorter hospital stay (2.7 ± 1.2 vs. 4.8 ± 1.6 days; p < 0.001). Patients undergoing surgery had higher serum β-hCG levels and more severe clinical presentations, reflecting differences in baseline disease severity. Both laparoscopic surgery and methotrexate-based medical management were effective when applied according to appropriate clinical indications. Laparoscopic surgery was associated with a higher unadjusted treatment success rate, whereas medical management offered the advantage of a shorter hospital stay. As treatment allocation was based on clinical judgment rather than randomization, these findings should be interpreted with caution. Individualized treatment based on clinical condition, serum β-hCG levels, and ultrasonographic findings remains essential for optimizing patient outcomes.