{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:30:50Z","timestamp":1793370650365,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T00:00:00Z","timestamp":1689206400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Tubal ectopic pregnancy (TEP) is a common gynaecological emergency. Several medical and surgical treatment options exist, but it is not clear which is the safest and most effective treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare the effectiveness of expectant, medical and surgical treatment options for TEP using a systematic review and network meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search Strategy<\/jats:title><jats:p>MEDLINE, EMBASE, and CENTRAL from inception till September 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection Criteria<\/jats:title><jats:p>Randomised trials that evaluated any treatment option for woman with a TEP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection and Analysis<\/jats:title><jats:p>We performed pairwise and network meta\u2010analyses using a random effect model. We assessed the studies' risk of bias, heterogeneity and network inconsistency. We reported primarily on TEP resolution and treatment failure using relative risk (RR) and 95% confidence\u2010intervals (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>We included 31 randomised trials evaluating ten treatments (<jats:italic>n<\/jats:italic>\u2009=\u20092938 women). Direct meta\u2010analysis showed no significant benefit for using methotrexate compared to expectant management for TEP resolution. Network meta\u2010analysis showed similar effect\u2010size for most conservative treatment options compared to expectant management for TEP resolution (glucose intra\u2010sac instillation vs. expectant RR 0.84, 95% CI 0.63\u20131.12; methotrexate intra\u2010sac instillation vs. expectant RR 0.91, 95% CI 0.75\u20131.10; multi\u2010dose methotrexate vs. expectant RR 1.00, 95% CI 0.88\u20131.15; prostaglandin intra\u2010sac instillation vs. expectant RR 0.75, 95% CI 0.53\u20131.07; salpingotomy vs. expectant RR 0.99, 95% CI 0.84\u20131.16; single dose methotrexate vs. expectant RR 0.97, 95% CI 0.85\u20131.10; single dose methotrexate\u2009+\u2009mifepristone vs. expectant RR 1.09, 95% CI 0.89\u20131.33). All treatment options showed a higher risk of failure compared to salpingectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is insufficient evidence to support the use of any medical treatment option for TEP over expectant management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17594","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T04:44:10Z","timestamp":1689309850000},"page":"5-14","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Effectiveness of treatment options for tubal ectopic pregnancy: A\u00a0systematic review and network meta\u2010analysis"],"prefix":"10.1111","volume":"131","author":[{"given":"Bassel H.","family":"Al\u00a0Wattar","sequence":"first","affiliation":[{"name":"Beginning Assisted Conception Unit Epsom and St Helier University Hospitals  London UK"},{"name":"Comprehensive Clinical Trials Unit Institute of Clinical Trials &amp; Methodology, University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Solangon","sequence":"additional","affiliation":[{"name":"Women's Health Department University College London Hospitals  London UK"},{"name":"EGA Institute for Women\u2019s Health Faculty of Population Health Sciences, University College London (UCL)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2563-2605","authenticated-orcid":false,"given":"Lucrezia V.","family":"de\u00a0Braud","sequence":"additional","affiliation":[{"name":"Women's Health Department University College London Hospitals  London UK"},{"name":"EGA Institute for Women\u2019s Health Faculty of Population Health Sciences, University College London (UCL)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewelina","family":"Rogozi\u0144ska","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit at UCL Institute of Clinical Trials &amp; Methodology, University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davor","family":"Jurkovic","sequence":"additional","affiliation":[{"name":"Comprehensive Clinical Trials Unit Institute of Clinical Trials &amp; Methodology, University College London  London UK"},{"name":"EGA Institute for Women\u2019s Health Faculty of Population Health Sciences, University College London (UCL)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,13]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Diagnosis and Management of Ectopic Pregnancy","author":"Green\u2010top Guideline No. 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