Curative effect of HIFU in management of different types of ectopic pregnancy

What is it about?

Ectopic pregnancy (EP) could be defined as any embryo that got implanted in any site rather than the endometrial cavity. Lately, different types of EP were reportedly managed by high-intensity focused ultrasound (HIFU). We aimed to pool all available data in a systematic review without meta-analysis and investigate the efficacy and safety tendencies of HIFU among different types of EP. We applied our comprehensive terms in Google Scholar, PubMed, Scopus, Ovid, and PubMed Central databases from their inception until September 23. Retrieved references were gathered using EndNote in which we omitted the duplicates and exported the record for screening. Data regarding characteristics, safety and efficacy outcomes, and baseline information of the enrolled population were extracted. The eligible case reports were assessed using a tool by Murad and colleagues, while the quality of the included cohorts was appraised using the NIH tool. We retrieved 6637 studies, which were scrutinized by titles and abstracts. We scrutinized the full texts of 36 studies and ultimately included a total of 17 studies. All studies were conducted in China, and on different types of ectopic pregnancy including tubal, cervical, intramural, caesarian scar, and corneal ectopic pregnancy. The mean age of enrolled patients was 33.03 years, and we pooled a total sample of 853 patients. The follow-up period varied widely among the included studies, ranging from 1.3 months to up to 69 months. Normal menstruation recurred after a mean of 35 days, as reported by nine studies. Most of the included studies reported normal β-HCG after around 30–40 days. Twelve studies with 757 patients reported a cumulative incidence of 179 cases of abdominal pain after HIFU. Neither of the enrolled patients reportedly complained of skin burn after HIFU. We suggested managing EP patients with HIFU, especially when seeking further conceiving. High-quality randomized controlled trials are required to draw a stronger level of evidence. We found that HIFU was a safe and effective treatment for EP, with no serious complications reported. We recommend HIFU as a potential option for patients with different kinds of EP, especially those who want to preserve their fertility. However, we also acknowledge the need for more high-quality RCTs that compare HIFU with other interventions for each type of EP, using consistent and reliable outcomes. This would help to produce stronger evidence and recommendations in the future.

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Photo by CDC on Unsplash

Photo by CDC on Unsplash

Why is it important?

We found that HIFU was a safe and effective treatment for EP, with no serious complications reported. We recommend HIFU as a potential option for patients with different kinds of EP, especially those who want to preserve their fertility. However, we also acknowledge the need for more high-quality RCTs that compare HIFU with other interventions for each type of EP, using consistent and reliable outcomes. This would help to produce stronger evidence and recommendations in the future.

Perspectives