Interventions for non-tubal ectopic pregnancy

Area of Science:

• Reproductive Medicine and Surgery
• Gynecologic Oncology
• Minimally Invasive Surgery

Background:

• Non-tubal ectopic pregnancy, including caesarean scar pregnancy (CSP), is a rare condition with increasing incidence.
• Implantation outside the uterine cavity or fallopian tubes can occur in the caesarean scar, cervix, ovary, or abdomen.

Purpose of the Study:

• To evaluate the clinical effectiveness and safety of surgical, medical, and expectant management for non-tubal ectopic pregnancy.
• To assess fertility outcomes and complication rates associated with different treatment modalities.

Main Methods:

• Systematic search of multiple databases for randomized controlled trials (RCTs) up to December 2019.
• Inclusion of five RCTs (303 women) primarily focusing on caesarean scar pregnancy (CSP).
• Comparison of uterine artery embolization/chemoembolization (UAE/UACE) with methotrexate (MTX) versus systemic MTX, and hysteroscopic versus ultrasonographic-guided suction curettage.

Main Results:

• Uncertainty regarding differences in success rates, complications, and adverse events between UAE/UACE and systemic MTX for CSP (low-quality evidence).
• Significantly lower blood loss observed with UAE/UACE followed by suction curettage compared to systemic MTX (moderate-quality evidence).
• Uncertainty regarding the effectiveness of hysteroscopic versus ultrasonographic-guided suction curettage for CSP (very low-quality evidence).

Conclusions:

• Evidence is insufficient to definitively conclude on the superiority of UAE/UACE over systemic MTX for CSP treatment success or complications.
• UAE/UACE demonstrates a potential benefit in reducing blood loss during treatment for CSP.
• Further high-quality RCTs are needed, especially for non-CSP non-tubal ectopic pregnancies, for which no studies were identified.