The quality of evidence is downgraded by imprecise results (few patients).
A multicentre RCT 2 included 73 women who were assigned to systemic single dose methotrexate (MTX) treatment or expectant management, using a web-based randomization program, block randomization with stratification for hospital and serum hCG concentration (under 1000 versus 1000 - 2000 IU/l). There was no difference in primary treatment success rate of single-dose MTX versus expectant management, 31/41 (76%) and 19/32 (59%), respectively (RR 1.3; 95% CI 0.9 to 1.8). In 9 women (22%), additional MTX injections were needed, compared with 9 women (28%) in whom systemic MTX was administered after initial expectant management (RR 0.8; 95% CI 0.4 to 1.7). One woman (2%) from the MTX group underwent surgery compared with 4 women (13%) in the expectant management group (RR 0.2; 95% CI 0.02 to 1.7), all after experiencing abdominal pain within the first week of follow-up. In the MTX group, 9 women reported side effects versus none in the expectant management group. No serious adverse events were reported. Single-dose systemic MTX does not have a larger treatment effect compared with expectant management in women with an ectopic pregnancy or a pregnancy of unknown location and low and plateauing serum hCG concentrations.
A clinical trial 3 assessed the success rate of expectant management compared with methotrexate or surgery (n=48). Surgery was the first-line treatment in 9 (18.8%) cases. Non-surgical managemen were offered for 38 women: 19 (39.6%) had methotrexate (MTX) and 19 (39.6%) were managed expectantly. The median initial serum hCG level and ectopic size were not significantly different between any of the groups according to initial treatment. The overall success rate of expectant management was 89.5%. There were no cases of ectopic rupture in this group. Length of follow-up ranged from 7 to 141 days with a median duration of follow-up of 50.6 days.
A Cochrane review [Abstract] 1 included 35 studies on the treatment of tubal ectopic pregnancy, describing 25 different comparisons. Systemic methotrexate in a fixed multiple dose intramuscular regimen has a non significant tendency to a higher treatment success than laparoscopic salpingostomy (1 RCT, n = 100, OR 1.8, 95% CI 0.73 to 4.6). No significant differences are found in long term follow up (n=74): intra uterine pregnancy (OR 0.82, 95% CI 0.32 to 2.1) and repeat ectopic pregnancy (OR 0.87, 95% CI 0.19 to 4.1). Expectant management was significantly less successful than prostaglandin therapy (1 RCT, n = 23, OR 0.08, 95% CI 0.02 to 0.39).
Date of latest search: 2018-04-23
Primary/Secondary Keywords