Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients’ health-related quality of life

Objective: To compare patients’ health-related quality of life after systemic methotrexate therapy versus laparoscopic salpingostomy for tubal pregnancy. Design: Multicenter randomized clinical trial. Setting: Departments of obstetrics and gynecology of six Dutch hospitals. Patient(s): Hemodynamically stable patients with a laparoscopically confirmed unruptured tubal pregnancy without signs of active bleeding, who were randomly assigned to undergo either systemic methotrexate therapy or laparoscopic salpingostomy. Intervention(s): Standard health-related quality of life questionnaires administered before and 2 days, 2 weeks, 4 weeks, and 16 weeks after confirmative laparoscopy. Main Outcome Measure(s): Health-related quality of life. Result(s): Health-related quality of life was impaired most severely 2 days after confirmative laparoscopy in both treatment groups and improved during follow-up. Health-related quality of life was impaired more severely after systemic methotrexate therapy than after laparoscopic salpingostomy. Medically treated patients had more limitations in physical functioning, role functioning, and social functioning; had worse health perceptions, less energy, more pain, more physical symptoms, and a worse overall quality of life; and were more depressed than surgically treated patients. Conclusion(s): Systemic methotrexate therapy had a more negative impact on patients’ health-related quality of life than did laparoscopic salpingostomy. This negative impact on patients’ health-related quality of life of systemic methotrexate therapy should be taken into account when deciding on the appropriate therapy for tubal pregnancy.