Ectopic pregnancy is the leading cause of pregnancy-related deaths in the first trimester of pregnancy. Its incidence has increased to between one and two percent of pregnancies. Chinese herbal medicines have been used to treat this condition in China and other countries. The review authors investigated 281 studies that claimed to be randomised controlled trials and that used Chinese herbal medicines in the treatment of ectopic pregnancy.Only two of these studies were confirmed to be randomised controlled trials. Both trials were of poor quality in terms of design and how they were conducted.These studies did not provide clear evidence that CHM is beneficial in the treatment of ectopic pregnancy.
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Traditionally Chinese herbal medicine (CHM) has been used widely in Chinese hospitals to treat ectopic pregnancy. Many studies have been published supporting its use but the evidence has not been systematically reviewed. This is and update of the review published in 2007.
Objectives
To determine the effectiveness and safety of CHM in the treatment of ectopic pregnancy.
Search strategy
Computerised databases (CENTRAL (The Cochrane Library), MEDLINE, EMBASE, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP, Traditional Chinese Medicine Database System) were searched from their inception to November 2010 for relevant trials.
Selection criteria
Randomised controlled trials (RCT) on the use of CHM for the treatment of ectopic pregnancy.
Data collection and analysis
Original authors of the identified studies were contacted to determine the trial design and identify authentic RCTs. Two review authors extracted and analysed the data.
Main results
The search identified 281 trials. Only two studies involving a total of 157 participants were confirmed to be authentic RCTs (Li 2004c; Zhao 2000). Both were of poor methodological quality with a high risk of conflicted interest and potential for bias in favour of the intervention. We could not reach a definitive conclusion from the results. The pooled result showed that adding a Western medicine to CHM resulted in a significantly higher treatment success rate than with CHM alone (RR 1.33, 95% CI 1.08 to 1.63). When CHM plus Western medicine was compared to CHM alone for the time to disappearance of abdominal pain, again the results favoured the arm that included Western medicine (RR -2.09, 95% CI -4.14 to -0.04). Results were inconsistent for the time required for human chorionic gonadotropin (beta-hCG) to return to normal. One study favoured CHM plus Western medicine over Western medicine (with or without placebo) (MD -6.68, 95% CI -11.49 to -1.87); when CHM plus Western medicine was compared to CHM alone the results favoured the arm that included Western medicine (MD -8.12, 95% CI -10.89 to -5.53).
Authors' conclusions
We have not found any well-designed trials investigating Chinese herbal medicines in the treatment of ectopic pregnancy. We cannot support or refute any CHM preparation for clinical use on the basis of evidence from randomised controlled trials.
