Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for most outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Women with tubal ectopic pregnancy
Intervention: Expectant management (monitor hCG levels, clinical monitoring, scans)
Comparison: Medical management with methotrexate
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Resolution of ectopic pregnancy: overall | No statistically significant difference | Very Low |
Resolution of ectopic pregnancy: hCG at presentation <500 IU/l | No statistically significant difference | Moderate |
Resolution of ectopic pregnancy: hCG at presentation 501 to 1000 IU/l | No statistically significant difference | Very Low |
Resolution of ectopic pregnancy: size at presentation (<35 mm) | No statistically significant difference | Low |
Tubal rupture | See note ᵃ | Low |
Additional treatment needed: overall | No statistically significant difference | Very Low |
Additional treatment needed: hCG at presentation <500 IU/l | No statistically significant difference | Low |
Additional treatment needed: hCG at presentation 501 to 1000 IU/l | No statistically significant difference | Very Low |
Additional treatment needed: size at presentation (<35 mm) | No statistically significant difference | Very Low |
HRQoL (change from baseline to 4 weeks): physical component scale (SF-36) (better indicated by lower values) | No statistically significant difference | Moderate |
HRQoL (change from baseline to 4 weeks): mental component scale (SF-36) (better indicated by lower values) | No statistically significant difference | Moderate |
HRQoL (change from baseline to 4 weeks): physical symptoms (RSCL) (better indicated by lower values) | No statistically significant difference | Moderate |
HRQoL (change from baseline to 4 weeks): depression (HADS) (better indicated by lower values) | No statistically significant difference | Low |
HRQoL (change from baseline to 4 weeks): anxiety (HADS) (better indicated by lower values) | No statistically significant difference | Moderate |
Recommendations as stated in the source guideline Offer expectant management as an option to women who: Are clinically stable and pain free AND Have a tubal ectopic pregnancy measuring less than 35 mm with no visible heartbeat on transvaginal ultrasound scan AND Have serum hCG levels of 1000 IU/L or less AND Are able to return for follow-up. Consider expectant management as an option for women who: Are clinically stable and pain free AND Have a tubal ectopic pregnancy measuring less than 35 mm with no visible heartbeat on transvaginal ultrasound scan AND Have serum hCG levels above 1000 IU/L and below 1500 IU/L AND Are able to return for follow-up.
Note The guideline committee made a strong recommendation for expectant management where serum hCG was less than 1000 IU/L as this was consistent with levels in most of the women included in the studies. A conditional recommendation was made for women with serum hCG levels above 1000 but less than 1500 IU/L as there was less evidence available. ᵃ No events in both arms.
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