Outcomes of Medical versus Surgical Management of Ectopic Pregnancy in Emergency Settings: A Systematic Review

Background: Ectopic pregnancy requires early assessment of hemorrhage risk, treatment suitability, and future reproductive priorities. Medical and surgical approaches differ in immediate effectiveness, surveillance requirements, and subsequent fertility This review compares outcomes of methotrexate and surgery for tubal ectopic pregnancy, emphasizing applicability to emergency care. Methods: This study was conducted according to PRISMA guidelines and we analyzed twelve comparative studies published before June 2026. Randomized trials and comparative cohorts were examined for treatment success, additional intervention, biochemical resolution, complications, subsequent pregnancy, recurrence, and resource use. Results were synthesized narratively because treatment regimens, surgical procedures, eligibility criteria, and outcome definitions differed. Results: Seven randomized trials and five observational studies informed the comparison. Individual trials reported methotrexate success of 65%-94.7%, with definitions differing regarding repeat doses. Surgery produced faster biochemical resolution, while additional methotrexate or rescue surgery remained necessary in some medically treated patients. Randomized fertility comparisons identified no statistically significant advantage for either strategy. A large population cohort associated methotrexate with higher subsequent live birth and recurrent ectopic pregnancy, alongside greater healthcare utilization. Treatment selection and baseline severity complicated observational comparisons. Conclusion: Methotrexate provides an effective option for selected stable patients with unruptured tubal pregnancy and reliable follow-up. Surgery provides rapid definitive treatment and remains essential for instability or suspected rupture.