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Comparative efficacy of tube-sparing interventions for tubal ectopic pregnancy: a systematic review and network
Can Shi1, Han Wang1, Tianqi Yang1
1Department of Obstetrics and Gynecology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, China.
Aim:
To compare the efficacy, safety, and reproductive outcomes of tube-sparing interventions for tubal ectopic pregnancy (TEP).
Methods:
PubMed, Web of Science, CENTRAL, and Embase were searched from inception to June 2026 for randomized controlled trials. The protocol was registered in PROSPERO (CRD420261429862), and reporting followed PRISMA-NMA guidance. A frequentist random-effects network meta-analysis was performed. The primary outcomes were treatment success and failure rates. Secondary outcomes included time to hormone normalization, re-injection rate, adverse events, and subsequent natural intrauterine pregnancy rate.
Results:
Thirty-five randomized trials involving 3,211 patients and 11 interventions were included. For treatment success, most interventions did not differ significantly from single-dose methotrexate (MTX). Expectant management showed a lower success rate (RR 0.79, 95% CI 0.68-0.93). Salpingotomy plus MTX ranked highest for success (SUCRA 91.0%), but the effect estimate was not statistically significant versus single-dose MTX (RR 1.17, 95% CI 0.98-1.40). For treatment failure, expectant management increased failure risk (OR 3.33, 95% CI 1.09-10.13), whereas salpingotomy reduced it (OR 0.26, 95% CI 0.08-0.85). Multi-dose MTX increased adverse events (OR 1.63, 95% CI 1.18-2.24). No significant differences were observed in subsequent natural intrauterine pregnancy.
Conclusion:
Most tube-sparing strategies did not improve treatment success over single-dose MTX. Salpingotomy may reduce treatment failure, whereas expectant management carries higher failure risk. Multi-dose MTX requires caution because of increased adverse events.