Incidence, diagnostic challenges, and management outcomes of ectopic pregnancy: a retrospective study

Abstract Background Ectopic pregnancy remains a leading cause of first-trimester maternal mortality worldwide, yet Jordanian data on ectopic pregnancy are outdated and derived from small, single-center studies conducted more than a decade ago. This study aimed to report the incidence, diagnostic challenges, and management outcomes of ectopic pregnancy at the largest tertiary hospital in Jordan. Methods This was a retrospective, descriptive, single-center study of all patients treated for ectopic pregnancy at Al Bashir Hospital between January 1, 2023, and June 20, 2025. Eligibility criteria and clinical indications determined the management approach. Electronic medical records were reviewed for demographics, clinical details, and treatment data. Descriptive analyses, comparative tests (Fisher’s exact or Chi-square test as appropriate), and multivariable logistic regression analysis were used to identify independent predictors of key clinical outcomes. 95% confidence intervals were calculated for major rates. Results The incidence of ectopic pregnancy was 8.99 per 1,000 deliveries (95% CI 7.98–10.09), and the most prevalent clinical characteristics were previous miscarriage (37.54%) and previous cesarean sections. (33.54%). Medical management with Methotrexate was used in 91 patients (success rate 79.12%, 95% CI 69.68–86.21%). Among the 214 surgically managed confirmed ectopic pregnancies (195 primary surgery; 19 salvage surgery after Methotrexate failure), laparotomy was the predominant approach (85.05%, 95% CI 79.65–89.20%), and the majority were ruptured (66.36%, 95% CI 59.79–72.35%). Postoperative complications comprised 4 (1.87%) wound infections and 3 (1.40%) bowel obstructions. Of all 253 surgeries performed (234 primary; 19 salvage), 15.42% (95% CI 11.49–20.38%) were for a presumed ectopic pregnancy not confirmed during surgery or on histopathology, and histology failed to confirm ectopic pregnancy in 3.59% (95% CI 1.75–7.22%) of 195 tubal salpingectomy specimens, highlighting diagnostic challenges. Pelvic free fluid was the sole independent predictor of tubal rupture (aOR 37.3, 95% CI 12.7–109.2, p-value < 0.001), and initial β-hCG titer was the only independent predictor of Methotrexate success (Firth aOR 0.17, 95% CI 0.04–0.66, p-value 0.011). Conclusion This study provides updated epidemiological data on ectopic pregnancy from the largest tertiary hospital in Jordan. Our incidence estimate (8.99 per 1,000 deliveries) was higher than historically reported local Jordanian figures. Competency in early pregnancy ultrasonography and enhanced training are essential for accurate, timely diagnosis and improved outcomes.