A systematic review of single-dose intramuscular methotrexate for the treatment of ectopic pregnancy Parker J, Bisits A, Proietto A M Authors' objectives To determine the efficacy, side-effects and complications of single-dose intramuscular methotrexate for the primary treatment of ectopic pregnancy. Searching MEDLINE was searched from 1968 to 1997 inclusive for articles published in any language. The bibliographies of the identified studies were examined and the first author's bibliographic database was reviewed. The authors of relevant studies were contacted for further information about published and unpublished and/or incomplete studies. Study selection Study designs of evaluations included in the review Studies in which 1 or 2 doses of methotrexate were used to treat more than 10 patients with ectopic pregnancy were included if the patients fulfilled the criteria for participation. Individual case reports of side-effects and complications were reviewed separately. Specific interventions included in the review Methotrexate. The interventions included the use of 1 or 2 intramuscular doses of methotrexate (50 mg/m2). Participants included in the review Women with a diagnosis of ectopic pregnancy, made using a combination of serum human chorionic gonadotrophin (HCG) titres, ultrasound and/or curettage as described by Stoval et al. (see Other Publications of Related Interest no.1), with ultrasound demonstration of an ectopic pregnancy of less than 3.5 cm in the greatest dimension. The mean age of the women across studies ranged from 26.1 to 33.3 years. The mean pre-treatment HCG ranged from 1,388 to 3,950 mIU/mL. Outcomes assessed in the review The primary outcomes were defined as regression of HCG to nonpregnant levels after 1 or 2 intramuscular doses of methotrexate. The secondary outcomes included the mean time to resolution, and the incidence of side-effects and complications. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the authors performed the selection. Assessment of study quality The quality of the studies was assessed using the modified rating system developed by Chalmers et al., which was described by Petitti et al. (see Other Publications of Related Interest no.2). The authors do not state how the papers were assessed for quality, or how many of the authors performed the quality assessment. Data extraction The data were independently extracted by the three authors with any differences being resolved by consensus. Data were sought on the following prespecified areas: patient demographics, treatment outcomes, side-effects and complications. Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2019 University of York Page: 1 / 3