What Is The Effectiveness Of Non-surgical Interventions In The Management Of Ectopic Pregnancies In LMICs?

GASOC International Conference 2025
ABSTRACT FIRST PRESENTED: 24.10.2025

doi: 10.52648/GASOC.1006_330

What Is The Effectiveness Of Non-surgical Interventions In The Management Of Ectopic Pregnancies In LMICs?

Nike Ajijola , Melat Beyene, Kimberly Gichuki, Mabel Kabutey, Kiah Wright, Clare Taylor
University of Birmingham College of Medicine and Health, Birmingham, United Kingdom; University of Birmingham Department of Applied Health Sciences, Birmingham, United Kingdom

Introduction: Ectopic pregnancies occur when a fertilised egg implants outside of the endometrium of uterus, with over 90% occurring in the fallopian tubes. As the fertilised egg grows, it can rupture, leading to internal bleeding; therefore, women with ectopic pregnancies require immediate medical attention. Ectopic pregnancies are a leading cause of maternal mortality globally, with incidence significantly higher in low- and middle-income countries (LMICs). However, there is limited research ectopic pregnancy management in these regions. This review aims to evaluate the effectiveness of non-surgical management options for tubal ectopic pregnancies in LMICs.

Methods: The following databases were searched from inception to January 2025: Turning Research into Practice; Guidelines International Network, PubMed, Cochrane, OVID and Epistemonikos. The search yielded two guidelines, two systematic reviews and four randomised control trials (RCTs) which were appraised using the appropriate tool.

Results: Both guidelines recommended methotrexate as the treatment option. The systematic reviews suggested two-dose methotrexate protocols were more effective than single- or multi-dose protocols, though single-dose methotrexate was associated with fewer side effects.
The RCTs suggested that a 10-day regimen of oral letrozole may be more favourable due to its higher success rate, lower cost and minimal side effects.

Conclusion: Current evidence shows methotrexate is an effective, universal standard of care for the non-surgical management of ectopic pregnancy. Some RCTs suggest that Letrozole could be a more effective, cheaper alternative, though further research with higher sample sizes is required to reach the statistical power to confidently make this recommendation.

Keywords: Ectopic Pregnancy, Medical management, Low and middle income countries

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