Conservative treatment of ectopic pregnancies using a single echo-guided injection of methotrexate into the gestational sac.

The authors describe the possibility of the conservative treatment of five early ectopic pregnancies. A single injection of methotrexate into the tubal gestational sac was performed under vaginal ultrasound guidance. In all five cases, a clear ectopic gestational sac could be visualized. The pregnancies dated from the 5th to the 7th week of amenorrhea. Strict ultrasound follow-up following injection showed a gradual reduction in the size of the tubal gestational sac. At the same time, plasma beta-hCG gradually decreased to zero after a maximum time period of 25 days. Subsequent hysterosalpingography performed on all of the women demonstrated bilateral normal patent tubes.It is concluded that, in selected patients, transvaginal injection provides an alternative relatively non-invasive approach to the management of ectopic pregnancy. It is proposed that the adoption of a policy of earlier diagnosis and treatment may lead to a reduction in the incidence of some tubal causes of infertility.     

小剂量甲氨喋呤治疗异位妊娠的护理

对异位妊娠患者给予口服甲氨蝶呤（MTX）片剂治疗。患者用药期间,由责任护士建立保守治疗护理计划、制定严格的观察记录表格,将患者服药时间、药量准确记录,严密观察病情变化,及用药后的反应,加强对患者的生活护理和饮食指导。严密的观察、优质的护理、及时的心理疏导是保守治疗成功的保证。     

甲氨蝶呤两种用药方案治疗异位妊娠的研究

目的评价甲氨蝶呤两种不同用药方案治疗异位妊娠的疗效。方法将行保守治疗的异位妊娠患者194例随机、双盲分为研究组96例和对照组98例,研究组给予甲氨蝶呤(MTX)两次用药治疗,对照组给予甲氨蝶呤单次用药治疗,比较两组的疗效和安全性。结果在MTX治疗成功中,研究组中重复单次MTX用药低于对照组,差异有统计学意义(χ2=4.22,P<0.05)。研究组的成功率高于对照组,差异有统计学意义(χ2=4.21,P<0.05)。研究组血清β-HCG恢复至正常时间和阴式B超随诊盆腔包块消失时间均短于对照组,差异均有统计学意义(t分别=3.43、1.03,P均<0.05)。两组在患侧输卵管通畅率之间比较,差异有统计学意义(χ2=3.91,P<0.05),但在双侧输卵管通畅率、不通畅率方面比较,差异均无统计学意义(χ2分别=1.28、2.01,P均>0.05)。两组患者治疗过程副反应发生较多是胃肠道反应,且两组间的差异有统计学意义(χ2=5.95,P<0.05),两组其余的常见副反应为口腔溃疡、骨髓抑制、肝功能损害比较,差异均无统计学意义(χ2分别=2.10、2.17、3.24,P均>0.05)。结论甲氨蝶呤两次用药法治疗异位妊娠疗效优于单次用药方案,且毒副反应较少。     

Sonographically guided minimally invasive treatment of unusual ectopic pregnancies.

OBJECTIVE: To present our experience with sonographically guided treatment of unusual ectopic pregnancies, defined as heterotopic pregnancies and pregnancies occurring at ectopic locations other than the extracornual portion of the fallopian tube. METHODS: We retrieved and reviewed all cases of unusual ectopic pregnancies that underwent sonographically guided therapy at our institution. Twenty-seven cases were identified, from 1992 through 2003, including 18 cervical, 6 cornual, 1 tubal heterotopic, and 2 cesarean scar implantations. RESULTS: All of the cervical ectopic, cornual ectopic, and tubal heterotopic pregnancies were treated by sonographically guided injection of potassium chloride into the ectopic gestational sac or fetus. Guidance was via transvaginal sonography in all 18 cervical pregnancies, 3 of the 6 cornual pregnancies, and the tubal heterotopic pregnancy, and via transabdominal sonography in 3 cornual ectopic pregnancies. One of the cesarean scar pregnancies was treated by transvaginally guided potassium chloride injection, and the other was treated via transabdominally guided dilation and evacuation. Treatment was successful in 25 of the 27 patients, including all 23 patients with an ectopic pregnancy and no concomitant intrauterine pregnancy. Four patients had concomitant intrauterine and ectopic pregnancies (1 cervical, 2 cornual, and 1 tubal); in 3 the intrauterine fetuses resulted in live-born infants, and in the fourth the intrauterine pregnancy was electively terminated. Eight of the 27 patients had subsequent intrauterine pregnancies. CONCLUSIONS: Sonographically guided minimally invasive treatments of unusual ectopic pregnancies are safe and effective alternatives to surgical and systemic medical therapy. These treatments ablate the ectopic pregnancy, permit normal continuation of a concomitant intrauterine pregnancy, and preserve the uterus for subsequent pregnancies.     

Effect of methotrexate treatment of ectopic pregnancy on subsequent pregnancy

Question My last pregnancy was diagnosed as ectopic, and I was treated successfully with intramuscular methotrexate (MTX) 8 weeks ago. I am currently planning for another pregnancy; however, I have read that MTX causes birth defects and that it stays in my body for a very long time, ranging from 1 to 12 months after treatment. When is it safe to conceive?Answer We suggest that the outcomes of pregnancies conceived shortly after MTX therapy for extrauterine pregnancy are most likely to be favourable and similar to those pregnancies conceived 6 months after MTX treatment. However, as data are not sufficient to draw a definitive conclusion or to confirm the exact safe timing after MTX treatment, at least a 3-month waiting period is recommended for women who are planning pregnancy. Nevertheless, conception within 3 months of MTX treatment of extrauterine pregnancy should not be considered a definite indication of termination, and further targeted fetal anatomy assessment is recommended. Further retrospective and prospective studies are needed to define the safety period before 3 months and to solidify this recommendation.     

Rupture of ectopic pregnancy after medical therapy with methotrexate: a case series

Medical treatment of ectopic pregnancy with methotrexate has become the standard of care in many areas of the U.S. Rupture of ectopic pregnancy after medical treatment presents a diagnostic challenge to the Emergency Physician. We review a series of 11 patients with ectopic pregnancy treated with methotrexate who then required surgical treatment for rupture.     

宫腔镜下插管注射MTX治疗持续异位妊娠的临床体会

目的探讨宫腔镜下插管注药治疗持续异位妊娠的可行性。方法对6例药物保守治疗失败的病人采取宫腔镜下插管注药(MTX)，观察hCG、附件区包块的变化、腹部体征、肝肾功能。结果6例病人均成功治愈，达到临床目的，无1例出现并发症。结论宫腔镜下插管注药治疗持续异位妊娠微创、痛苦小、经济、简单、安全、有效。     

Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies.

OBJECTIVE: The use of methotrexate (MTX) for the treatment of tubal ectopic pregnancy (EP) has become common practice, although the factors associated with a favorable outcome are not totally clear. The aim of this study was to investigate the predictors of successful MTX treatment. METHODS: One hundred and thirty-seven women with unruptured tubal EP in whom the hematosalpinx could be directly visualized by pelvic ultrasound were studied. Women who met the inclusion criteria were treated with MTX either: 50 mg/m(2) intramuscularly (n = 70) or with 1 mg/kg injected directly into the hematosalpinx under sonographic guidance (n = 67). The associations between the outcome of the treatment and different factors studied (human chorionic gonadotropin (hCG) level, progesterone level, hematosalpinx diameter, hemoperitoneum volume and mode of MTX administration) were analyzed. RESULTS: The overall success rate, defined by a post-treatment normal hCG level (< 10 mIU/mL), was 79.6%. The initial hCG level and the route of administration of MTX appeared to be two independent factors that predicted success. Multivariate analysis demonstrated that the success rate was significantly better when MTX was administered locally: the odds ratio (OR) was 9.7 (95% CI, 3.1-30), and was significantly poorer when the hCG level was >/= 1000 mIU/mL (P < 0.002): the OR was 0.10 (95% CI, 0.07-0.49). CONCLUSION: Among selected women with tubal EPs, the route of administration of MTX and the initial level of serum hCG are the most important factors associated with the success of medical treatment.     

不同方案甲氨蝶呤保守治疗异位妊娠临床分析

目的探讨两种不同方案甲氨蝶呤(Methotrexate,MTX)保守治疗异位妊娠的疗效及不良反应。方法将2009年8月至2011年8月我院诊断的符合保守治疗的255例异位妊娠患者分为两组。A组选用MTX 0.4 mg/(kg.d)肌肉注射,5天为1疗程,间隔1周可开始第二疗程。B组选用MTX+甲酰四氢叶酸钙(CF)方案,MTX 1 mg/kg肌肉注射,一日1次,次日CF 0.1 mg/kg肌肉注射,1剂MTX和1剂CF作为一次化疗剂量,总量为4次剂量,间隔1周可开始第二疗程。结果 B组有效率优于A组,差异有统计学意义(χ2=6.269,P<0.05),两组不良反应和疗程比较差异均无统计学意义(P>0.05)。结论MTX+CF方案疗效优于单纯MTX肌肉注射,且不良反应及疗程无明显增加,值得临床推广应用。     

Uterine artery embolization in association with methotrexate infusion for the treatment of tubal ectopic pregnancy

Objective To investigate the safety, feasibility, and effectiveness of uterine artery embolization in association with methotrexate (MTX) infusion for the treatment of tubal ectopic pregnancy.Methods Fifty-one patients with tubal ectopic pregnancy were referred for interventional management. All patients received super-selective arteriography of the uterine artery, were infused with 50–100 mg methotrexate (MTX) through a catheter, and underwent embolization of the uterine artery with a gel-foam pledge. Clinical presentation, findings of physical examination, β-HCG values, and the size of the ectopic mass were documented for comparison. The concentration of MTX in blood was evaluated at 0.5, 6, 12, 24, 36, and 48 hours after the procedure.Results Forty-seven out of the 51 patients had clinical resolution of their tubal pregnancy (92.2%). The average time for the β-HCG value to decrease and come back to normal was 9.16 ± 2.54 days (mean +/− SD). MTX levels in peripheral blood could not be detected for patients who received 50 or 75 mg MTX at 36 hours after the procedure, while the MTX level was 0.01 μmol/L at 48 hours after the procedure for patients who received 100 mg. Out of the 4 cases whose ectopic mass size was ≥5 cm, 3 failed to respond to the treatment; however, those whose ectopic mass size was ≤5 cm responded positively to the treatment, regardless of the β-HCG concentration and abdominal bleeding, except for 1 patient who had to undergo laparoscopy for severe abdominal pain and who showed a reduction in her β-HCG level.Conclusion Uterine artery embolization in association with methotrexate infusion is safe and effective in the treatment of tubal ectopic pregnancy, especially for those women with mild to moderate bleeding, or for those at risk of a major hemorrhage. The selection criterion of mass size >5 cm should, therefore, be carefully considered.     

Role of sonography in the recognition, assessment, and treatment of cesarean scar ectopic pregnancies.

OBJECTIVE: Cesarean scar ectopic pregnancies (CSEPs) are rare but may have serious adverse consequences and are therefore important to promptly recognize on sonography. We aim to describe the typical sonographic appearances. Potential treatments are discussed, including sonographic guidance for transcervical injection of methotrexate (MTX) into the gestational sac. METHODS: Two patients with CSEPs were treated with systemic and intra-amniotic administration of MTX under sonographic guidance. RESULTS: Both patients were followed clinically after medical treatment, resulting in low maternal morbidity and mortality. CONCLUSIONS: Considering the increasing rate of cesarean delivery and the increased risk of CSEPs, sonologists should be familiar with the sonographic appearances of a pregnancy implanted into the cesarean scar. We show how to correctly diagnose scar implantation and describe how to perform sonographically guided transcervical injection of MTX.     

经阴道超声对异位妊娠单剂量氨甲喋呤治疗结果的预测价值

目的研究经阴道超声对异位妊娠氨甲蝶呤（MTX）治疗结果的预测价值。方法回顾性总结106例经MTX治疗的异位妊娠患者的经阴道超声声像图表现。结果异位妊娠囊内探及胎心及卵黄囊者均治疗失败。异位妊娠包块小于1．5cm的病例均治疗成功。治疗成功组和治疗失败组在1．5cm以上包块大小、包块表现形式、盆腔积液、低阻动脉血流的存在等方面的差异均无显著性意义。结论经阴道超声二维声像图表现对预测异位妊娠MTX治疗结果有一定价值，彩色多普勒血流成像的预测价值尚需进一步研究。     

异位妊娠应用甲氨蝶呤与米非司酮保守治疗的效果研究

目的:研究异位妊娠(EP)应用甲氨蝶呤(MTX)配合米非司酮进行保守治疗的安全性与有效性。方法:回顾分析90例EP患者的临床资料,根据用药方案进行分组:45例单用MTX治疗者为对照组,45例应用MTX+米非司酮治疗者为观察组,比较两组的临床疗效与不良反应。结果:观察组的治愈率为95.56%,显著高于对照组的82.22%(P0.05);治疗1、2周后,两组血β-HCG均显著性降低,且组间比较差异显著(P0.05);观察组的血β-HCG转阴时间、包块消失时间与住院时间均较对照组显著缩短(P0.05);两组不良反应率比较无明显差异(P0.05)。结论:MTX与米非司酮联合应用于治疗EP具有显著疗效,能够促进病情康复、提高治愈率,且副反应较少。     

肌肉注射甲氨蝶呤与口服米非司酮保守治疗86例宫外孕的临床疗效观察

目的观察肌肉注射甲氨蝶呤与口服米非司酮保守治疗宫外孕的临床疗效。方法将纳入研究的156例宫外孕患者参照简单随机分组法原则,通过投掷硬币的方法分为观察组(86例)和对照组(70例),对照组给予甲氨蝶呤60mg/m2单次注射,观察组给予甲氨蝶呤50mg/m2单次注射,并配合口服米非司酮100mg口服每12h服用1次,连用3d治疗。之后观察两组患者临床疗效,以及症状消失、血β-人绒毛膜促性腺激素(β-HCG)转阴及住院时间,并密切观察不良反应发生情况。结果观察组治愈82例,保守治疗失败4例,治愈率95.3%;对照组治愈53例,保守治疗失败17例,治愈率75.7%,观察组治愈率明显高于对照组(P0.05);观察组患者临床症状消失时间、血β-HCG转阴时间及平均住院日与对照组比较,各指标差异均有统计学意义(P0.05);观察组不良反应率12.8%,对照组不良反应率17.1%,两组不良反应发生率比较差异无统计学意义(P0.05)。结论肌肉注射甲氨蝶呤与口服米非司酮保守治疗宫外孕疗效确切,安全性可靠,值得临床推广应用。