Abstract
Background: Ectopic pregnancy (EP) is a leading cause of acute abdominal pain in gynecology. Most women with tubal EP present hemodynamically stable, making non-surgical therapy a viable option. This study aimed to evaluate the effectiveness and safety of methotrexate (MTX) regimens in this population.
Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs). A comprehensive search of PubMed, Cochrane Library, Embase, LILACS, SciELO, and CINAHL was conducted from database inception to April 2025. Eligible trials compared methotrexate regimens in hemodynamically stable women with tubal EP. The primary outcome was treatment success, defined as resolution of serum hCG without surgical intervention. Secondary outcomes included adverse effects, treatment duration, number of injections, and operative rate. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.
Results: Eight RCTs including 1,015 women were analyzed. Overall treatment success was 81.3% with single-dose MTX compared to 82.7% with multidose regimens (RR 0.98, 95% CI 0.92–1.05). Adverse effects were significantly lower with single-dose regimens (RR 0.62, 95% CI 0.45–0.85). No significant differences were observed in operative rates (RR 1.07, 95% CI 0.89–1.28) or duration of treatment.
Conclusion: Among hemodynamically stable women with tubal EP, single-dose MTX is as effective as multidose regimens but is associated with fewer adverse effects. Given its non-invasive nature, lower cost, and feasibility of administration in an outpatient or offsite setting, MTX therapy is recommended as the first-line treatment for appropriately selected patients.
Keywords
Methotrexate, Tubal ectopic pregnancy, Hemodynamically stable, Randomized controlled trials, Meta-analysis