***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To compare the direct and indirect costs of single dose systemic methotrexate with laparoscopic surgery for the treatment of unruptured ectopic pregnancy OBJECTIVE Our goal was to determine whether laparoscopic salpingostomy is preferable to laparoscopic methotrexate injection in the management of unruptured tubal gestation . STUDY DESIGN Forty-eight patients with unruptured tubal pregnancy were prospect ively r and omized to either laparoscopic salpingostomy or laparoscopic local methotrexate injection in a university medical center . Operation time , duration of hospital stay , decrease in levels of beta-human chorionic gonadotropin , and fertility outcome were compared between the two groups . RESULTS The salpingostomy group had a longer operative time ( p < 0.0001 ) but a shorter hospital stay ( p < 0.01 ) and a lower incidence of persistent trophoblastic activity ( 5 % vs 14 % ) , although this difference did not reach statistical significance . The time interval until beta-human chorionic gonadotropin disappearance was similar ( 13.9 and 13.7 days ) , and the subsequent intrauterine pregnancy rate was similar in the two groups ( 83.5 % and 81 % ) . One repeat tubal pregnancy occurred in the salpingostomy group . CONCLUSIONS Both these methods of conservative management are equally effective and each one has its merits OBJECTIVE To compare a local injection of hyperosmolar glucose and salpingostomy for the laparoscopic treatment of tubal pregnancy in terms of immediate success and postoperative tubal patency . DESIGN Prospect i ve . PATIENTS , SETTING : Forty women with an unruptured tubal pregnancy were enrolled from among 117 women with ectopic pregnancies ( EPs ) admitted consecutively to the university clinic . The inclusion criteria were as follows : [ 1 ] concentration of beta-hCG in the serum < or = 5,000 IU/L ; [ 2 ] no living fetus in the EP ; and [ 3 ] unruptured tubal pregnancy at laparoscopy . INTERVENTIONS After r and omization , 20 of these patients were treated with a local injection of hyperosmolar ( 50 % ) glucose solution and 20 women by salpingostomy .  Tubal patency was evaluated at relaparoscopy or by hysterosalpingography 6 to 13 months after the primary treatment . RESULTS The mean decrease in beta-hCG concentration from the preoperative value to the first postoperative day was 37 % and 52 % in the glucose and salpingostomy groups , respectively , and the mean resolution time was 13 and 12 days , respectively . Human chorionic gonadotropin showed a persistent EP in 4 women ( 20 % ) in the glucose group and 2 ( 10 % ) in the salpingostomy group . A patent treated tube was found in 9 of 13 women in the glucose group and 9 of 10 in the salpingostomy group at re-examination . During a follow-up of 6 to 20 months 4 women in the glucose group and 4 women in the salpingostomy group had an intrauterine pregnancy . CONCLUSION A local injection of hyperosmolar glucose is a reasonable method treating tubal pregnancy in selected cases but does not seem to offer any advantage over salpingostomy concerning persistent trophoblastic disease rate Thirty-four women with unruptured tubal ectopic pregnancy ( EP ) were r and omly assigned to undergo salpingotomy without tubal suturing ( n = 15 ) or salpingotomy with tubal suturing ( n = 19 ) . The reproductive performance of these patients was compared with 24 patients who underwent salpingectomy for their EP ( historical control ) . Using life table analysis , the cumulative probability of intrauterine pregnancy ( IUP ) at 12 and 24 months was 45 % and 45 % after salpingotomy without tubal suturing and 21 % and 47 % after salpingotomy with tubal suturing , respectively . The cumulative probability of IUP after salpingectomy ( 21 % and 26 % at 12 and 24 months , respectively ) was significantly lower than after salpingotomy with or without tubal suturing . There was no difference in the cumulative probability of EP after salpingotomy with or without tubal suturing , but it was significantly higher than after salpingectomy . In 18 women who subsequently underwent laparoscopy or laparotomy  , no significant difference was found between the degree of adhesions after salpingotomy with or without tubal suturing . These findings suggest that IUP after conservative treatment is higher than after salpingectomy , but recurrent EP is also higher . Intrauterine pregnancy occurs earlier after salpingotomy without tubal suturing than after salpingotomy with tubal suturing . This might be because of rapid return of tubal function after healing by secondary intention Objective To investigate whether the incidence of persistent ectopic pregnancy after linear salpingostomy can be reduced by prophylactic administration of a single dose of methotrexate postoperatively . Methods Women who underwent linear salpingostomy for treatment of unruptured ectopic pregnancy and who agreed to participate in the study ( n = 129 ) were r and omly assigned to the prophylaxis or control group . Women with anemia , renal insufficiency , or liver disease were excluded . In the prophylaxis group , patients received a single dose of methotrexate , 1 mg/kg intramuscularly , within 24 hours postoperatively . No treatment was used in the control group . Both groups were followed with serial serum β-hCG titers ; titers were measured on the seventh postoperative day , then every 72 hours until levels were lower than 15 mIU/mL. A blood count and chemistry panel were also obtained on postoperative day 7 , and any side effects related to methotrexate were noted . Persistent ectopic pregnancy was defined as a rise in the serum β-hCG level or a decline of less than 20 % between two consecutive measurements taken 3 days apart . Results A total of 116 women completed the postoperative follow-up : 54 in the prophylaxis group and 62 in the control group . Ten women had persistent ectopic pregnancy , one in the prophylaxis group ( 1.9 % ) and nine among the controls ( 14.5 % ) ; this difference was statistically significant ( P < .05 ) . The relative risk of developing persistent ectopic pregnancy after prophylactic methotrexate was 0.13 ( 95 % confidence interval 0.02 , 0.97 ) . Three women ( 5.5 % ) reported mild side effects  after methotrexate , but these resolved spontaneously . Conclusion The incidence of persistent ectopic pregnancy was significantly reduced after a single prophylactic dose of systemic methotrexate administered postoperatively . This regimen is safe and can be used to decrease the extent of postoperative monitoring after conservative treatment of unruptured ectopic pregnancy The long-term reproductive outcome in patients treated with linear salpingostomy for ectopic gestation was similarly impacted by laparoscopy and laparotomy , further establishing laparoscopic salpingostomy as the preferable treatment modality . Patients with two consecutive ectopic gestations may not benefit from the conservative surgical approach because it may predispose them to a high risk of recurrence Ectopic pregnancy may be a result of previous tubal damage and a cause of further reduction of tubal function ( 1 ) . The condition is now usually recognized at an early stage , enabling intervention prior to total tubal damage . Salpingotomy by laparoscopy , and non-surgical procedures such as systemic methotrexate injections or local injections into the gestational sac have , in part , replaced salpingectomy , on the hypothesis that this will preserve tubal patency and fertility ( 2 4 ) . Recently , we reported treatment of  ectopic pregnancy in 80 women by local injection of hypertonic ( 50 % ) glucose into the gestational sac  , by r and om application guided either by transvaginal sonography or by laparoscopy ( 5 ) . Criteria for inclusion were : 1 ) ectopic pregnancy < 4 cm seen by transvaginal sonography , 2 ) hCG < 3000 IUA , and 3 ) little or no intraabdominal bleeding . Thirty-nine patients were r and omized into the sonography and 41 into the laparoscopy group . We found that 53 of 80 women ( 66.3 % ) were successfully treated ; 82.1 % ( 32 of 39 women ) in the sonography group compared to 51.20/(1 ( 21 of 41 women ) in the laparoscopy group . Of 28 successfully treated women later investigated by  hysterosalpingography  ( HSG ) , 25 women ( 89.3 % ) had an open treated tube , and in 19 ( 67.8 % ) both tubes were normal . A question naire was sent to all 53 successfully treated patients , 23 - 5 1 months after treatment . Tnformation about postectopic reproductive outcome was obtained from 51 patients ( 96.20/0 ) , and is presently reported . Statistical comparisons were performed as appropriate with Student ’s t-test or Fisher ’s test of exact probability ; p<0.05 was considered significant BACKGROUND Medical treatment of ectopic pregnancies is common . To increase the efficacy of methotrexate , the association of mifepristone has been proposed . METHODS We performed a large prospect i ve multicentre double-blind sequential r and omized trial in order to compare the efficacy of methotrexate and mifepristone ( 600 mg given orally ) versus methotrexate and placebo . RESULTS A total of 212 ectopic pregnancies was r and omized . There was no significant difference in the initial characteristics between the two groups . There was no significant difference in the success rate of medical treatment between the methotrexate-mifepristone ( n = 113 ) and the methotrexate-placebo group ( n = 99 ) : 79.6 % ( 90/113 ) versus 74.2 % ( 72/97 ) respectively , RR ( 95 % CI ) : 1.07 ( 0.92 - 1.25 ) , P = 0.41 , non-significant . However , there was a quantitative interaction between progesterone level and effect of treatment : when progesterone level was > /=10 ng/l , the efficacy of the combination of mifepristone and methotrexate was significantly higher than the combination of methotrexate and placebo , with an 83.3 % success rate ( 15/18 ) versus 38.5 % ( 5/13 ) respectively . CONCLUSIONS Our study failed to demonstrate any benefit of the addition of mifepristone to methotrexate . By contrast , the quantitative interaction between treatment effect and baseline serum progesterone suggested that this combination could be limited to ectopic pregnancies associated with high serum progesterone concentrations OBJECTIVE To evaluate the fertility outcome after laparoscopic surgery for ectopic pregnancy . DESIGN A r and omized trial versus laparotomy was performed between May 1987 and June 1989 . SETTING The study was conducted in a clinical university center , the Sahlgrens Hospital . PATIENTS A group of 105 patients with tubal pregnancy were stratified with regard to risk determinants and age and r and omized to laparoscopy or laparotomy .  Eighty-seven patients who desired pregnancy were evaluated for subsequent fertility outcome . INTERVENTIONS Linear salpingotomy was performed in both surgical groups . MAIN OUTCOME MEASURE We evaluated the fertility outcome after laparoscopic salpingotomy for comparison with the outcome after laparotomy . RESULTS There was no difference between the groups in the overall fertility outcome . A substantially higher proportion of patients in the laparotomy group were subjected to adhesiolysis performed at a second-look laparoscopy . CONCLUSIONS The fertility prospect s are not impaired by laparoscopic surgery . Adhesiolysis at a second-look laparoscopy , especially after laparotomy , might be beneficial in selected cases and may serve to improve subsequent fertility OBJECTIVE To explore the therapeutic effect and the mechanism of tubal pregnancy ( TP ) treated with integrated traditional Chinese and Western medicine ( TCM-WM ) . METHODS Seventy-eight patients suffering from TP were divided into two groups at r and om , 50 cases of treated group treated with the method of integrated Methotrexate ( MTX ) and Ectopic Pregnancy 2 ( EP2 ) decoction , and the other 28 cases treated with MTX alone for control . RESULTS The nonsurgical method cure rate of the treated group ( 98.0 % ) was higher than that of the control group ( 75.0 % , P < 0.01 ) . The intrauterine pregnancy rate of the treated group was 80.0 % , that of the control group was 42.9 % ( P < 0.01 ) . The recurrent TP rate of the treated group ( 4.0 % ) was lower than that of the control group ( 14.2 % , P < 0.01 ) . The serum beta-HCG normalizing time of the treated group ( 25.0 + /- 7.8 days ) was shorter than that of the control group ( 31.9 + /- 6.7 days , P < 0.05 ) . The 
    Output:
    
Subsequent fertility did not differ between the interventions studied .
This meta- analysis shows that laparoscopic surgery is the most cost-effective treatment for tubal EP .
Systemic MTX is a good alternative in selected patients with low serum hCG concentrations