Effectiveness of treatment options for tubal ectopic pregnancy: A systematic review and network meta‐analysis

Abstract 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 To compare the effectiveness of expectant, medical and surgical treatment options for TEP using a systematic review and network meta‐analysis. Search Strategy MEDLINE, EMBASE, and CENTRAL from inception till September 2022. Selection Criteria Randomised trials that evaluated any treatment option for woman with a TEP. Data Collection and Analysis 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 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 There is insufficient evidence to support the use of any medical treatment option for TEP over expectant management.