Tubal ectopic pregnancy.

Abstract

INTRODUCTION Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others continue to grow and can lead to rupture of the tube. Risks are higher in women who smoke or have damage to the fallopian tubes due to pelvic infections, surgery, or previous ectopic pregnancy. METHODS AND OUTCOMES We conducted a systematic overview aiming to answer the following clinical question: What are the effects of treatments for unruptured tubal ectopic pregnancy on subsequent fertility? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS At this update, searching of electronic databases retrieved nine studies. After deduplication and removal of conference abstracts, nine records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of six studies and the further review of three full publications. Of the three full articles evaluated, no systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for three PICO combinations. CONCLUSIONS In this systematic overview we present information relating to the effectiveness and safety of the following interventions for unruptured tubal ectopic pregnancy on subsequent fertility: expectant management, methotrexate, salpingotomy, and salpingectomy.