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Methotrexate versus expectant management in ectopic pregnancy: a meta-analysis

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Abstract

Background

Ectopic pregnancy (EP) affects 1–2% of all pregnant females'(Barnhart et al., Expert Opin Pharmacother 2(3):409–417, 2001) that can require emergent surgical intervention.

Noninvasive diagnostic tests like transvaginal ultrasound (TVUS), and serial β-hCG levels have enabled early diagnosis and allowed medical therapy to be tried.

Methotrexate (MTX) versus expectant management, both have been considered safe but superiority of one over the other is lacking.

Methods

We searched for RCT that have shown efficacy of MTX versus expectant management in hemodynamically stable patients. Our primary outcome was whether one modality is superior to the other.

Results

Four RCT were included in the meta-analysis after review. Our pooled analysis when comparing MTX and expectant management showed us that the difference between the uneventful decline in β-hCG levels (treatment success) was statistically insignificant (RR = 1.06, 95% CI 0.93–1.21) with no significant heterogeneity between trials (I2 = 0.0%, P = 0.578).

The difference between need for surgical intervention between methotrexate and expectant management was also statistically insignificant (RR = 0.77, 95% CI 0.43–1.40) with no significant heterogeneity between trials (I2 = 0.0%, P = 0.552).

Conclusion

We conclude that expectant management is not inferior to MTX in hemodynamically stable patients with ectopic pregnancy that have declining or low β-hCG levels.

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Authors

Contributions

AKN project development, data collection, manuscript writing (Discussion) and editing. MUA data analysis, data collection, manuscript writing (Results) and editing. AH forming tables, manuscript writing (Introduction) and referencing. SNM forming tables and manuscript writing (Methods).

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Correspondence to Ahmed Kunwer Naveed.

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The authors declare no competing interests.

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All the RCT selected for this meta-analysis had taken consent form their respective patient population.

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Naveed, A.K., Anjum, M.U., Hassan, A. et al. Methotrexate versus expectant management in ectopic pregnancy: a meta-analysis. Arch Gynecol Obstet 305, 547–553 (2022). https://doi.org/10.1007/s00404-021-06236-y

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