Effectiveness of treatment options for tubal ectopic pregnancy: A systematic review and network meta-analysis.
ectopic pregnancy
laparoscopy
methotrexate
network meta-analysis
salpingotomy
systematic review
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
Jan 2024
Jan 2024
Historique:
revised:
13
06
2023
received:
04
04
2023
accepted:
15
06
2023
medline:
5
12
2023
pubmed:
14
7
2023
entrez:
14
7
2023
Statut:
ppublish
Résumé
Tubal ectopic pregnancy (TEP) is a common gynaecological emergency. Several medical and surgical treatment options exist, but it is not clear which is the safest and most effective treatment. To compare the effectiveness of expectant, medical and surgical treatment options for TEP using a systematic review and network meta-analysis. MEDLINE, EMBASE, and CENTRAL from inception till September 2022. Randomised trials that evaluated any treatment option for woman with a TEP. We performed pairwise and network meta-analyses using a random effect model. We assessed the studies' risk of bias, heterogeneity and network inconsistency. We reported primarily on TEP resolution and treatment failure using relative risk (RR) and 95% confidence-intervals (CI). We included 31 randomised trials evaluating ten treatments (n = 2938 women). Direct meta-analysis showed no significant benefit for using methotrexate compared to expectant management for TEP resolution. Network meta-analysis showed similar effect-size for most conservative treatment options compared to expectant management for TEP resolution (glucose intra-sac instillation vs. expectant RR 0.84, 95% CI 0.63-1.12; methotrexate intra-sac instillation vs. expectant RR 0.91, 95% CI 0.75-1.10; multi-dose methotrexate vs. expectant RR 1.00, 95% CI 0.88-1.15; prostaglandin intra-sac instillation vs. expectant RR 0.75, 95% CI 0.53-1.07; salpingotomy vs. expectant RR 0.99, 95% CI 0.84-1.16; single dose methotrexate vs. expectant RR 0.97, 95% CI 0.85-1.10; single dose methotrexate + mifepristone vs. expectant RR 1.09, 95% CI 0.89-1.33). All treatment options showed a higher risk of failure compared to salpingectomy. There is insufficient evidence to support the use of any medical treatment option for TEP over expectant management.
Sections du résumé
BACKGROUND
BACKGROUND
Tubal ectopic pregnancy (TEP) is a common gynaecological emergency. Several medical and surgical treatment options exist, but it is not clear which is the safest and most effective treatment.
OBJECTIVES
OBJECTIVE
To compare the effectiveness of expectant, medical and surgical treatment options for TEP using a systematic review and network meta-analysis.
SEARCH STRATEGY
METHODS
MEDLINE, EMBASE, and CENTRAL from inception till September 2022.
SELECTION CRITERIA
METHODS
Randomised trials that evaluated any treatment option for woman with a TEP.
DATA COLLECTION AND ANALYSIS
METHODS
We performed pairwise and network meta-analyses using a random effect model. We assessed the studies' risk of bias, heterogeneity and network inconsistency. We reported primarily on TEP resolution and treatment failure using relative risk (RR) and 95% confidence-intervals (CI).
MAIN RESULTS
RESULTS
We included 31 randomised trials evaluating ten treatments (n = 2938 women). Direct meta-analysis showed no significant benefit for using methotrexate compared to expectant management for TEP resolution. Network meta-analysis showed similar effect-size for most conservative treatment options compared to expectant management for TEP resolution (glucose intra-sac instillation vs. expectant RR 0.84, 95% CI 0.63-1.12; methotrexate intra-sac instillation vs. expectant RR 0.91, 95% CI 0.75-1.10; multi-dose methotrexate vs. expectant RR 1.00, 95% CI 0.88-1.15; prostaglandin intra-sac instillation vs. expectant RR 0.75, 95% CI 0.53-1.07; salpingotomy vs. expectant RR 0.99, 95% CI 0.84-1.16; single dose methotrexate vs. expectant RR 0.97, 95% CI 0.85-1.10; single dose methotrexate + mifepristone vs. expectant RR 1.09, 95% CI 0.89-1.33). All treatment options showed a higher risk of failure compared to salpingectomy.
CONCLUSIONS
CONCLUSIONS
There is insufficient evidence to support the use of any medical treatment option for TEP over expectant management.
Identifiants
pubmed: 37443463
doi: 10.1111/1471-0528.17594
doi:
Substances chimiques
Methotrexate
YL5FZ2Y5U1
Mifepristone
320T6RNW1F
Prostaglandins
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
5-14Informations de copyright
© 2023 John Wiley & Sons Ltd.
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