SynthesisActa obstetricia et gynecologica Scandinavica2023
Methotrexate vs expectant management for treatment of tubal ectopic pregnancy: An individual participant data meta-analysis.
Synthesis in Acta obstetricia et gynecologica Scandinavica, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Methotrexate vs expectant management for treatment of tubal ectopic pregnancy: An individual participant data meta-analysis.Acta obstetricia et gynecologica Scandinavica · 2023Pooled it
- Article
- The diagnosis and management of extrauterine and uterine ectopic pregnancy.Human reproduction update · 2026Review
- Pharmacokinetics and Monitoring of Methotrexate in Adults with Acute Lymphoblastic Leukaemia: A 10-Year Follow-Up at an Italian Centre.Journal of clinical medicine · 2025Article
- Hysteroscopic Tubal Flushing Combined With Laparoscopic Milking for Ectopic Pregnancy Removal: A Case Report and Literature Review.Clinical case reports · 2025Article
- The relationship between hemogram based inflammatory indices and prognosis in ectopic pregnancy cases treated with methotrexate.Scientific reports · 2025Article
- Methotrexate vs. Surgery in the Management of Ectopic Pregnancy: A Comparative Analysis of Treatment Outcomes.Cureus · 2025Article
- The influence of smoking on the efficacy of a single-dose methotrexate treatment for ectopic pregnancy.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Article
- Enhancing decision-making in tubal ectopic pregnancy using a machine learning approach to expectant management: a clinical article.BMC pregnancy and childbirth · 2024Article
- Ectopic pregnancy.Nature reviews. Disease primers · 2024Review
- Ectopic pregnancy management and treatment strategies: A nationwide survey of Czech gynecological facilities.Women's health (London, England)Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionEctopic pregnancy is an important health condition which affects up to 1 in 100 women. Women who present with mild symptoms and low serum human chorionic gonadotrophin (hCG) are often treated with methotrexate (MTX), but expectant management with close monitoring is a feasible alternative. Studies comparing the two treatments have not shown a statistically significant difference in uneventful resolution of ectopic pregnancy, but these studies were too small to define whether certain subgroups could benefit more from either treatment. MATERIAL AND
methodsWe performed a systematic review and individual participant data meta-analysis (IPD-MA) of randomized controlled trials comparing systemic MTX and expectant management in women with tubal ectopic pregnancy and low hCG (<2000 IU/L). A one-stage IPD-MA was performed to assess overall treatment effects of MTX and expectant management to generate a pooled intervention effect. Subgroup analyses and exploratory multivariable analyses were undertaken according to baseline serum hCG and progesterone levels. Primary outcome was treatment success, defined as resolution of clinical symptoms and decline in level of serum hCG to <20 IU/L, or a negative urine pregnancy test by the initial intervention strategy, without any additional treatment. Secondary outcomes were need for blood transfusion, surgical intervention, additional MTX side-effects and hCG resolution times. TRIAL REGISTRATION NUMBER: PROSPERO: CRD42021214093.
results1547 studies reviewed and 821 remained after duplicates removed. Five studies screened for eligibility and three IPD requested. Two randomized controlled trials supplied IPD, leading to 153 participants for analysis. Treatment success rate was 65/82 (79.3%) after MTX and 48/70 (68.6%) after expectant management (IPD risk ratio [RR] 1.16, 95% confidence interval [CI] 0.95-1.40). Surgical intervention rates were not significantly different: 8/82 (9.8%) vs 13/70 (18.6%) (RR 0.65, 95% CI 0.23-1.14). Mean time to success was 19.7 days (95% CI 17.4-22.3) after MTX and 21.2 days (95% CI 17.8-25.2) after expectant management (P = 0.25). MTX specific side-effects were reported in 33 MTX compared to four in the expectant group.
conclusionsOur IPD-MA showed no statistically significant difference in treatment efficacy between MTX and expectant management in women with tubal ectopic pregnancy with low hCG. Initial expectant management could be the preferred strategy due to fewer side-effects.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.