{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T03:43:23Z","timestamp":1794368603852,"version":"4.9.0"},"reference-count":49,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Ectopic 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We performed a systematic review and individual participant data meta\u2010analysis (IPD\u2010MA) of randomized controlled trials comparing systemic MTX and expectant management in women with tubal ectopic pregnancy and low hCG (&lt;2000\u2009IU\/L). A one\u2010stage IPD\u2010MA 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 &lt;20\u2009IU\/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\u2010effects and hCG resolution times. Trial registration number: PROSPERO: CRD42021214093.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>1547 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\u20131.40). Surgical intervention rates were not significantly different: 8\/82 (9.8%) vs 13\/70 (18.6%) (RR 0.65, 95% CI 0.23\u20131.14). Mean time to success was 19.7\u2009days (95% CI 17.4\u201322.3) after MTX and 21.2\u2009days (95% CI 17.8\u201325.2) after expectant management (<jats:italic>P<\/jats:italic>\u2009=\u20090.25). MTX specific side\u2010effects were reported in 33 MTX compared to four in the expectant group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our IPD\u2010MA 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\u2010effects.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14617","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T15:53:12Z","timestamp":1687621992000},"page":"1159-1175","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Methotrexate vs expectant management for treatment of tubal ectopic pregnancy: An individual participant data meta\u2010analysis"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3293-5949","authenticated-orcid":false,"given":"Sarah Annie","family":"Solangon","sequence":"first","affiliation":[{"name":"Institute for Women's Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-213X","authenticated-orcid":false,"given":"Madelon","family":"Van\u00a0Wely","sequence":"additional","affiliation":[{"name":"Center for Reproductive Medicine Amsterdam University Medical Center  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute Amsterdam University Medical Center  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0805-2994","authenticated-orcid":false,"given":"Norah","family":"Van\u00a0Mello","sequence":"additional","affiliation":[{"name":"Amsterdam Reproduction and Development Research Institute Amsterdam University Medical Center  Amsterdam the Netherlands"},{"name":"Obstetrics and Gynecology Amsterdam University Medical Center  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8337-550X","authenticated-orcid":false,"given":"Ben W.","family":"Mol","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Department of Obstetrics and Gynecology Monash University  Clayton Victoria Australia"},{"name":"Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition University of Aberdeen  Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4168-6910","authenticated-orcid":false,"given":"Jackie A.","family":"Ross","sequence":"additional","affiliation":[{"name":"Early Pregnancy and Gynaecology Assessment Unit King's College London Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6487-5736","authenticated-orcid":false,"given":"Davor","family":"Jurkovic","sequence":"additional","affiliation":[{"name":"Institute for Women's Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","first-page":"81","article-title":"Centre for Maternal and Child Enquiries (CMACE). 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