Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: A systematic review and meta-analysis

F. Mol, B. W. Mol, W. M. Ankum, F. Van der Veen, P. J. Hajenius

Research output: Contribution to journalReview articlepeer-review

163 Citations (Scopus)


Background: To evaluate the effectiveness of surgery, medical treatment and expectant management of tubal ectopic pregnancy (EP) in terms of treatment success (i.e. complete elimination of trophoblast tissue), financial costs and future fertility. Methods: We searched for randomized controlled trials which described treatment interventions that have been widely adopted in clinical practice. A systemic literature search identified 15 trials. Results: Laparoscopic salpingostomy was significantly less successful than the open surgical approach (relative risk, RR 0.9, 95%; CI 0.82-0.99) due to a higher persistent trophoblast rate, but was significantly less costly. A prophylactic single shot methotrexate (MTX), given intramuscularly (i.m.) immediately post-operatively, significantly reduced persistent trophoblast after laparoscopic salpingostomy (RR 0.89, 95% CI 0.82-0.98, number needed to treat of 10). With systemic MTX in a fixed multiple dose i.m. regimen the likelihood of treatment success was higher than with laparoscopic salpingostomy (RR 1.15, 95% CI 0.93-1.43), but the difference was not significant. Systemic MTX in a fixed multiple dose i.m. regimen was only cost-effective if serum human chorionic gonadotrophin (hCG) concentrations were <3000 IU/l. If serum hCG concentrations were <1500 IU/l, then the single-dose MTX i.m. regimen-if necessary with additional MTX injections-was also cost-effective. Expectant management could not be evaluated yet. Subsequent fertility did not differ between the interventions studied. Conclusions: This meta-analysis shows that laparoscopic surgery is the most cost-effective treatment for tubal EP. Systemic MTX is a good alternative in selected patients with low serum hCG concentrations.

Original languageEnglish
Pages (from-to)309-319
Number of pages11
JournalHuman Reproduction Update
Issue number4
Publication statusPublished or Issued - Jul 2008
Externally publishedYes


  • Cost effectiveness
  • Ectopic pregnancy
  • Laparoscopy
  • Tophoblast

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this