Interventions for tubal ectopic pregnancy

Laparoscopic surgery is the intervention of choice for the treatment of tubal pregnancy. There seems to be no place for local methotrexate application under laparoscopic guidance. In cases involving early, non-complicated tubal pregnacy with low serum hCG concentration, systemic methotrexate may be preferred.

RHL Commentary by Pedro R. Figueroa-Casas

EVIDENCE SUMMARY

This review concludes that laparoscopic surgery is the intervention of choice for the conservative treatment of tubal pregnancy. There seems to be no place for local methotrexate application under laparoscopic guidance. In cases involving early, non-complicated tubal pregnacy with low serum hCG concentration, systemic methotrexate may be preferred. Although most patients indicated a preference for systemic methotrexate because of it being a non-invasive management strategy, health-related quality of life was more severely impaired after methotrexate as compared to laparoscopic surgery. Both subsequent intrauterine gestation and repeat ectopic pregnancy rates were similar (1).

Expectant management (no intervention, monitoring to see if tubal gestation regresses) was less successful than prostaglandin therapy.

All adequately controlled trials that could be identified have been included and appropriately analysed.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research
References

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This document should be cited as: Pedro R. Figueroa-Casas. Interventions for tubal ectopic pregnancy: RHL commentary (last revised: 11 December 2000). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com