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

Human Reproduction Update

Volumn 14, Issue 4, 2008, Pages 309-319

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

^a ACADEMIC MEDICAL CENTER   (Netherlands)

Author keywords

Cost effectiveness; Ectopic pregnancy; Laparoscopy; Tophoblast

Indexed keywords

CHORIONIC GONADOTROPIN; FOLINIC ACID; METHOTREXATE; MIFEPRISTONE; PLACEBO;

CHEMOPROPHYLAXIS; CLINICAL EFFECTIVENESS; CLINICAL PRACTICE; CLINICAL TRIAL; COCHRANE LIBRARY; COMBINATION CHEMOTHERAPY; CONFIDENCE INTERVAL; COST EFFECTIVENESS ANALYSIS; DRUG COST; DRUG DOSE COMPARISON; DRUG DOSE REGIMEN; FEMALE; FEMALE FERTILITY; GONADOTROPIN BLOOD LEVEL; HEALTH CARE COST; HUMAN; INFORMATION RETRIEVAL; INTERMETHOD COMPARISON; LAPAROSCOPIC SURGERY; MEDLINE; META ANALYSIS; MONOTHERAPY; PATIENT SELECTION; POSTOPERATIVE CARE; PRIORITY JOURNAL; REVIEW; RISK REDUCTION; SALPINGOSTOMY; SINGLE DRUG DOSE; SURGICAL APPROACH; SYSTEMATIC REVIEW; TREATMENT RESPONSE; TROPHOBLAST; UTERINE TUBE PREGNANCY; UTERINE TUBE SURGERY;

ABORTIFACIENT AGENTS, NONSTEROIDAL; FEMALE; HUMANS; INFERTILITY, FEMALE; METHOTREXATE; PREGNANCY; PREGNANCY, TUBAL; RANDOMIZED CONTROLLED TRIALS AS TOPIC; SALPINGOSTOMY; TREATMENT OUTCOME; TROPHOBLASTS;

EID: 45549108401     PISSN: 13554786     EISSN: 14602369     Source Type: Journal    
DOI: 10.1093/humupd/dmn012     Document Type: Review

References (73)

1. Alleyassin A, Khademi A, Aghahosseini M, Safdarian L, Badenoosh B, Akbari HE. Comparison of success rates in the medical, management of ectopic pregnancy with single-dose and multiple dose administration of methotrexate: A prospective, randomized clinical trial. Fertil Steril 2006; 85:1661-1666.
2. Ankum WM, Van der Veen F, Hamerlynck HV, Lammes FB. Suspected ectopic pregnancy. What to do when human chorionic gonadotropin levels are below the discriminatory zone. Suspected ectopic pregnancy. J Reprod Med 1995; 40:525 -528.
3. Bouyer J, Job-Spira N, Pouly J, Coste J, Germain E, Fernandez H. Fertility following radical, conservative-surgical or medical treatment for tubal pregnancy: A population-based study. BJOG 2000; 107 714-721.
4. Clausen I. Conservative versus radical surgery for tubal pregnancy. Acta Obstet Gynecol Scand 1996; 75:8-12.
5. Cohen DR, Falcone T, Khalife S, Hemmings R. Methotrexate: Local versus intramuscular. Fertil Steril 1996; 65:206-207.
6. Colacurci N, De FP, Zarcone R, Fortunato N, Passaro M, Mollo AA. Time length of negativization of hCG serum values after either surgical or medical treatment of ectopic pregnancy. Panminerva Medica 1998; 40:223-225.
7. Condous G, Okaro E, Khalid A, Timmerman DL, Zhou Y, van HS, Bourne T. The use of a new logistic regression model for prediciting the outcome of pregnancies of unknown location. Hum Reprod 2004; 19 1900-1910.
8. Dias Pereira G, Hajenius PJ, Mol BWJ, Ankum WM, Hemrika DJ, Bossuyt PMM. Fertility outcome after systemic methotrexate and laparoscopic salpingostomy for tubal pregnancy. Lancet 1999; 353:724-725.
9. Egarter C, Kiss H, Husslein P. Prostaglandin versus expectant management in early tubal pregnancy. Prostaglandins Leukot Essent Fatty Acids 1991; 42:177-179.
10. El-Sherbiny MT, El G I, Mera IM. Methotrexate verus laparoscopic surgery for the management of unruptured tubal pregnancy. Middle East Fertil Soc J 2003; 8:256-262.
11. Elmoghazy DAM, Nour-El-Dine NM. Prevention of persistent ectopic pregnancy with single dose methotrexate after surgical conservation of the tube. Abstracts of the XVI FIGO World Congress of Obstetrics and Gynecology, 2000, 57.
12. Fedele L, Bianchi S, Tozzi L, Zanconato G, Silvestre V. Intramesosalpingeal injection of oxytocin in conservative laparoscopic treatment for tubal pregnancy: Preliminary results. Hum Reprod 1998; 13:3042-3044.
13. Fernandez H, Baton C. Treatment of ectopic pregnancy by transvaginal aspiration: Prospective randomized clinical trial of Methotrexate versus Sulprostone by sonographic injection followed by systemic injection. Contraception, Fertilite, Sexualite 1990; 18:261-265.
14. Fernandez H, Baton C, Lelaidier C, Frydman R. Conservative management of ectopic pregnancy: Prospective randomized clinical trial of methotrexate versus prostaglandin sulprostone by combined trsanvaginal and systemic administration. Fertil Steril 1991; 55:746-750.
15. Fernandez H, Bourget P, Ville Y, Lelaidier C, Frydman R. Treatment of unruptured tubal pregnancy with methotrexate: Pharmacokinetic analysis of local versus intramuscular administration. Fertil Steril 1994; 62:943 -947.
16. Fernandez H, Pauthier S, Doumerc S, Lelaidier C, Olivennes F, Ville YY. Ultrasound guided injection of methotrexate versus laparoscopic salpingotomy in ectopic pregnancy. Fertil Steril 1995; 63 25-29.
17. Fernandez H, Pauthier S, Sitbon D, Vincent Y, Doumerc S. Role of conservative therapy and medical treatment in ectopic, pregnancy: literature review and clinical trial comparing Medical treatment and conservative laparoscopic treatment. Contraception Fertilite Sexualite 1996; 24:297-302.
18. Fernandez H, Yves VS, Pauthier S, Audibert F, Frydman R. Randomized trial of conservative laparoscopic treatment and methotrexate adminisbration in ectopic pregnancy and subsequent fertility. Hum Reprod 1998; 13: 3239-3243.
19. Fujishita A, Ishimaru T, Masuzaki H, Samejima T, Matsuwaki T, Ortega-Chavez RR. Local injection of methotrexate dissolved in saline versus methotrexate suspensions for the conservative treatment of ectopic pregnancy. Hum Reprod 1995; 10:3280-3283.
20. Fujishita A, Masuzaki H, Newaz KK, Kitajima M, Hiraki K, Ishimaru T. Laparoscopic salpingotomy for tubal pregnancy: Comparison of linear salpingotomy with and without suturing. Hum Reprod 2004; 19: 1195-1200.
21. Garbin O, de TR, de PL, Coiffic J, Lucot JP, Le-Goueff FF. Medical treatment of ectopic pregnancy; a randomized clinical trial comparing methotrexate-mifepristone and methotrexate-placebo. J Gynecol Obstet Biol Reprod 2004;33:391-400.
22. Gazvani MR, Baruah DN, Alfirevic Z, Emery SJ. Mifepristone in combination with methotrexate for the medical mangement of tubal pregnancy: A randomized controlled trial. Hum Reprod 1998; 13 1987-1990.
23. Gjelland K, Hordnes K, Tjugum J, Augensen K, Bergsjo P. Treatment of ectopic pregnancy by local injection of hypertonic glucose: A randomized trial comparing administration guided by transvaginal ultrasound or laparoscopy. Acta Obstet Gynecol Scand 1995; 74:629-634.
24. Gracia CR, Brown HA, Barnhart KT. Prophylactic methotrexate after linear salpingostomy: A decision analysis. Fertil Steril 2001; 76 1191-1195.
25. Graczykowski JW, Mishell DR. Methotrexate prophylaxis for persistent ectopic pregnancy after conservative treatment by salpingostomy. Obstet Gynecol 1997; 89:118-122.
26. Gray DT, Thorburn J, Lundroff P, Strandell A, Lindblom B. A cost-effectiveness study of a randomised trial of laparoscopy versus laparotomy for ectopic pregnancy. Lancet 1995; 345:1139-1143.
27. Hajenius P, Mot F, Mot B, Bossuyt P, Ankum W, Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev 2007; CD000324.
28. Hajenius PJ, Engelsbel S, Mol BWJ, Van der Veen F, Ankum WM, Bossuyt PMM. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet 1997; 350:774-779.
29. Hordnes K. Reproductive outcome after treatment of ectopic pregnancy with local injection of hypertonic glucose. Acta Obstet Gynecol Scand 1997; 76:703-705.
30. Hu CX, Han LX Mifepristone, in combination with methotrexate for the medical treatment of unruptured ectopic pregnancy. Acta Acadumiae Medicinae CPAPF 2003; 12:171-172.
31. Kaya H, Babar Y, Ozmen S, Ozkaya O, Karci M, Aydin AR. Intra tubal methotrexate for prevention of persistent ectopic pregnancy after salpingostomy. J Am Assoc Gynecol Laparosc 2002; 9:464-467.
32. Klauser CK, May WL, Johnson VK, Cowan BD, Hines RS. Methotrexate for ectopic pregnancy: A randomized single dose compared with multiple dose. Obstet Gynaecol 2005; 105:64S.
33. Koninckx PR, Witters K, Brosens J, Stemers N, Oosterlynck D, Meuleman C. Conservative laparoscopic treatment of ectopic pregnancies using the CO2 laser. Br J Obstet Gynaecol 1991; 98:1254-1259.
34. Korhonen J, Stenman U, Ylostalo P. Low-dose oral methotrexate with expectant management of ectopic pregnancy. Obstet Gynecol 1996; 88:775-778.
35. Laatikainen T, Tuomivaara L, Kaar K. Comparison of a local injection of hyperosmolar glucose solution with salpingostomy for the conservative treatment of tubal pregnancy. Fertil Steril 1993; 60:80-84.
36. Landstrom G, Bryman I, Ekstrom P, Engman M, Gunnarsson J, Hjersing MM. Ectopic pregnancy: Local medical treatment versus oral methotrexate therapy - a multicentre pilot study. Hum Reprod 1998; 13:38.
37. Lang PF, Weiss PA, Mayer HO, Haas JG, Honigl W. Conservative treatment of ectopic pregnancy with local injection of hyperosmolar glucose solution or prostaglandin F2a: A prospective randomised study. Lancet 1990; 336:78-81.
38. Lindblom B, Lundorff P, Thorburn J. Second-look laparoscopy after ectopic pregnancy. Proceedings of the 6th annual Congress of the European Scociety for Gynaecological Endoscopy, 1997, Supplement 21.
39. Lund J. Early ectopic pregnancy-comments on conservative treatment. J Obstet Gynecol Br Empire 1955; 62:70-76.
40. Lundorff P. Treatment of ectopics and subsequent adhesion formation. Prog Clin Biol Res 1993; 381:139-147.
41. Lundorff P. Laparoscopic surgery in ectopic pregnancy. Acta Obstet Gynecol Scand 1997; 164:81-84.
42. Lundorff P, Thorburn, J, Hahlin M, Kallfelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy. Acta Obstet Gynecol Scand 1991; 70:343-348.
43. Lundorff P, Thorbum J, Lindblom B. Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial. Fertil Steril 1992; 57:998-1002.
44. Lundorff P, Thorburn J, Lindblom B. Fertility after conservative surgical treatment of ectopic pregnancy, evaluated,in a randomized trial. Ugeskr Laeger 1993; 155:3282-3286.
45. Mol BW, Hajenius PJ, Ankum WM, Van der Veen F, Bossuyt PM. Conservative versus radical surgery for tubal pregnancy. Acra Obstet Gynecol Scand 1996; 75:806-867.
46. Mol BWJ, Hajenius PJ, Engelsbet S, Ankum WM, Van der Veen F, Hemrika DJ. Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive. Fertil Steril 1998a; 70:972-981.
47. Mol BWJ, Matthijsse HM, Tinga DJ, Huynh VT, Hajenius PJ, Ankum WM, Bossuyt PM, Van der Veen F. Fertility after conservative and radical surgery for tubal pregnancy. Hum Reprod 1998b; 13: 1804-1809.
48. Mol BW, Van der Veen F, Bossuyt PM. Implementation of probabilistic decision rules improves the predictive values of algorithms in the diagnostic management of ectopic pregnancy. Hum Reprod 1999a; 14:2855-2862.
49. Mol BWJ, Hajenius PJ, Engelsbel S, Ankum WM, Hermika DJ, Van der Veen F. The treatment of tubal pregnancy in The Netherlands: An economic evaluation of systemic methotrexate and laparoscopic salpingostomy. Am J Obstet Gynecol 1999b; 181:945-951.
50. Mottla GL, Rulin MC, Guzick DS. Lack of resolution of ectopic pregnancy by intratubal injection of methotrexate. Fertil Steril 1992; 57 685-687.
51. Murphy AA, Nager CW, Wujek JJ, Kettel LM, Torp VA, Chin HG. Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: A prospective trial. Fertil Steril 1992; 57:1180-1185.
52. Nieuwkerk PT, Hajenius PJ, Ankum WM, Van der Veen F, Wijker W, Bossuyt PMM. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tuba pregnancy. Part I. Impact on patients' health related quality of life. Ferfil Steril 1998a; 70:511-517.
53. Nieuwkerk PT, Hajenius PJ, Van der Veen F, Ankum WM, Wijker W, Bossuyt PMM. Systemic metbotrexate therapy versus laparoscopic salpingostomy in tubal pregnancy. Part II Patient preferences for systemic methotrexate. Fertil Steril 1998b; 7:518-522.
54. Peng LX. The comparison of three, conservative treatments for ectopic pregnancy; analysis of 97 cases. Guangxi Med J 1997; 19: 752-754.
55. Porpora MG, Oliva MM, De CA, Montanino, G, Cosmi EV. Comparison of local methotrexate and linear salpingostomy in the conservative laparoscopic treatment of ectopic pregnancy. J Am Assoc Gynecol Laparosc 1996; 3:271-276.
56. Rozenberg P, Chevret S, Camus E, de TR, Garbin O, Poncheville LL. Medical treatment of ectopic pregnancies: A randomized clinical trial comapring methotrexate-mifepristone and methotrexate-placebo. Hum Reprod 2003; 18:1802-1808.
57. Sadan O, Ginath S, Debby A, Rotmensch S, Golan A, Zakut HH. Methotrexate versus hyperosmolar glucose in the treatment of extrauterine pregnancy. Arch Gynecol Obstet 2001; 265:82-84.
58. Saraj AJ, Wilcox JG, Najmabadi S, Stein SM, Johnson MB, Paulson RJ. Resolution of hormonal markers of ectopic gestation: A randomized trial comparing single dose intramuscular methotrexate with salpingostomy. Obstet Gynecol 1998; 92:989-994.
59. Sharma JB, Gupta S, Malhotra M, Arora R. A randomized controlled comparison of minilaparotomy and laparotomy in ectopic pregnancy cases. Indian J Med Sci 2003; 57:493-500.
60. Shea RT, Thompson GR, Harding A. Intra amniotic methotrexate versus CO2 laser laparoscopic salpingotomy in the management of tubal ectopic pregnancy a prospective randomized trial. Fertil Steril 1994; 62:876-878.
61. Shulman A, Maymon R, Zmira N, Loran M, Holtzinger M, Bahary C. Conservative treatment of ectopic pregnmcy and its effect on corpus luteum activity. Gynecol Obstet Invest 1992; 33:161-164.
62. Sowter MC, Farquhar CM, Gudex G. An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy. Br J Obstet Gynaecol 2001a; 108 204-212.
63. Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy. Br J Obstet Gynaecol 2001b; 108:192-203.
64. Su Y, Sun Y, Ma M. Observation on treatment of ectopic pregnancy by combination therapy of Chinese herbal medicine with Mifepristone or Methotrexate. Zhongguo Zhong Xi Yi Jie He Za zhi Zhongguo Zhongxiyi Jiehe Zazhi 2002; 22:417-419.
65. Tulandi T, Guralnick M. Treatment of tubal ectopic pregnancy by salpingotomy with or without tubal suturing and salpingectomy. Fertil Steril 1991; 55:53-55.
66. Tzafettas J, Anapliotis S, Zournatzi V, Boucklis A, Oxouzoglou N, Bondis J. Transvaginal intra amniotic injection of methotrexate in early ectopic pregnancy. Advantages over the laparoscopic approach. Early Hum Dev 1994; 39:101-107.
67. Ugur M, Yesilyurt H, Soysal S, Gokmen O. Prophylactic vasopressin during laparoscopic salpingotomy for ectopic pregnancy. J Am Assoc Gynecol Laparosc 1996; 3:365-368.
68. Vermesh M, Presser SC. Reproductive outcome after linear salpingostomy for ectopic gestation: A prospective 3 year follow up. Fertil Steril 1992; 57:682-684.
69. Vermesh M, Silva PD, Rosen GF, Stein AL, Fossum GT, Sauer MV. Management of unruptured ectopic gestation by linear salpingostomy: A prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecel 1989; 73:400-404.
70. Wang J, Yang Q, Yu Z. Clinical study of tubal pregnancy treated with integrated traditional Chinese and Western medicine. Zkongguuo Zhong Xi Yi Jie Z Zhi 1999; 18:531-533.
71. Wei FY, Chen HF. [Clinical analysis of 82 cases of ectopic pregnancy treated by methotrexate combined with traditional Chinese recipe]. Zhong Xi Yi Jie He Xue Bao 2003; 1:267, 292.
72. Yalcinkaya TM, Brown SE, Mertz HL, Thomas DW. A comparison of 25 mg/m2 vs 50 mg/m2 dose of methotrexate (MTX) for the treatment of ectopic pregnancy (EP). J Soc Gynecol Invest 2000; 7:179A.
73. Zilber U, Pansky M, Bukovsky I, Golan A. Laparoscopic salpingostomy versus laparoscopic local methotrexate injection in the management of unruptured ectopic gestation. Am J Obstet Gynecol 1996; 175 600-602.