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

Area of Science:

• Reproductive Medicine
• Gynecology
• Pharmacotherapy

Background:

• Ectopic pregnancy (EP) affects 1-2% of pregnancies, often requiring surgery.
• Early diagnosis via transvaginal ultrasound and β-hCG monitoring allows for medical management.
• Methotrexate (MTX) and expectant management are considered safe EP treatments, but their comparative efficacy is unclear.

Purpose of the Study:

• To compare the efficacy of methotrexate versus expectant management for hemodynamically stable ectopic pregnancies.
• To determine if one treatment modality is superior to the other in terms of treatment success and surgical intervention rates.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
• Searched for RCTs comparing MTX and expectant management in hemodynamically stable EP patients.
• Primary outcome was treatment success, defined by uneventful decline in β-hCG levels; secondary outcome was the need for surgical intervention.

Main Results:

• Four RCTs were included. Pooled analysis showed no statistically significant difference in treatment success (RR=1.06, 95% CI 0.93-1.21) between MTX and expectant management.
• No significant heterogeneity was observed (I²=0.0%, P=0.578).
• The need for surgical intervention was also statistically similar between groups (RR=0.77, 95% CI 0.43-1.40) with no significant heterogeneity (I²=0.0%, P=0.552).

Conclusions:

• Expectant management is not inferior to methotrexate for hemodynamically stable ectopic pregnancies with declining or low β-hCG levels.
• Both treatment options demonstrate comparable outcomes regarding treatment success and surgical intervention rates.
• This suggests expectant management is a viable alternative to MTX in selected EP cases.