ReviewThe medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens☆
Section snippets
Sources
Using OVID, we conducted a MEDLINE search (January 1966 through January 2001) restricted to the English language and using the key words “methotrexate,” “ectopic pregnancy,” and “tubal pregnancy.” A manual search of references was then conducted for additional articles. Articles selected for review included only those that reported the outcome of patients treated with either of the two standard protocols for the medical management of ectopic pregnancy. The majority of reports were case series
Study selection
A summary data set was created in an electronic database. Each patient was entered into the datasheet individually with as much descriptive information as provided by the report. Patients were classified according to the protocol intended for treatment. Exposure was defined as use of the single-dose protocol; the referent group was defined as those subjects assigned to the multidose protocol. Subjects were not reclassified if they received two doses while managed with the single-dose protocol
Results
A total of 213 articles met the search criteria, of which 76 articles were reviewed. The data from 26 articles were included in the analysis (Table 2). Overall, we reviewed 1327 cases of women diagnosed with ectopic pregnancy treated with methotrexate. The overall success rate for women treated with methotrexate for an ectopic pregnancy (using either treatment regimen) was 89% (1181 of 1327). The mean hCG level reported was 33,120.75 ± 3715 mIU/mL, with a range of 2–59,000. An increasing hCG
Conclusion
Treatment guidelines exist for medical management; however, there is currently no consensus on dose and frequency of administration.36 The single dose is more commonly used because of its simplicity and convenience for both the clinician and the patient. This is a systematic analysis of the published literature comparing the two regimens. These data provide a precise estimate of outcome, actual dosing patterns, and side effects, and they illustrate a number of important clinical points.
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Funding for this study was provided from the National Institutes of Health, grant RO1-HD-36455-01A1.