Extra-uterine pregnancy following assisted conception treatment

Ectopic pregnancy may be the only life-threatening disease in which prevalence has increased as mortality has declined. The most prominent theory to explain this phenomenon involves increased sensitivity of serum beta-human chorionic gonadotrophin (HCG) immunoassay and improved quality of transvaginal ultrasound, combined with a heightened awareness and increased suspicion of the condition among clinicians which has allowed early detection of ectopic pregnancy. Laparotomy, once the standard treatment of ectopic pregnancy, has been replaced almost entirely by operative laparoscopy. This is associated with a shorter hospital stay, fewer post-operative analgesic requirements, reduced costs and lower risk of adhesion formation. Laparotomy, however, remains necessary in cases with haemodynamic instability and with exceptional locations, e.g. cervical, abdominal and interstitial implantation. In selected cases, non-surgical management has also obtained high success rates. Among medical therapies, the most common is systemic or local administration of methotrexate. The other option is expectant management involving follow-up using serial serum HCG measurements and ultrasound scans. Thus, life-threatening ectopic pregnancy is now evolving into a medical disease, with the possibility of lower-cost treatment, faster recovery and higher subsequent fertility. In this review we assess the risk of extra-uterine implantation after assisted conception treatment, the accuracy of various diagnostic tools and focus on the efficacy, safety and the fertility outcomes of surgical and nonsurgical management of ectopic pregnancy.     

Return of reproductive performance after expectant management and local treatment for ectopic pregnancy.

The purpose of this study was to examine hysterosalpingographic findings and reproductive performance in patients previously managed non-surgically for ectopic pregnancy. Forty-nine patients with unruptured ectopic pregnancies were treated either by expectant management (n = 16) or medically (n = 33), using transvaginal methotrexate or sulprostone injection. The treatment was successful in 35 patients (71.5%), 12 out of 16 and 23 out of 33 in the two groups respectively. For all patients, follow-up currently varies from 3 to 52 months with a median follow-up of 16.6 +/- 11.2 months and 7.3 +/- 4.3 months in the two groups respectively. Hysterosalpingography was performed in 25 out of 26 patients who desired further pregnancy. We found evidence of tubal patency on the ectopic pregnancy treated side in 23 cases (92%). In this group, no recurrent ectopic pregnancy was observed. In the expectant management group, eight out of nine patients became pregnant, and the mean time to achieve pregnancy was 16.6 +/- 11.2 months. In the medical treatment group, eight out of 17 patients became pregnant and the mean time to achieve pregnancy was 8.6 +/- 4.2 months. In this last group, seven out of nine non-pregnant patients have had only a short follow-up, 4.5 +/- 3.2 months since treatment completion. No recurrent ectopic pregnancy was observed in this successfully treated group of patients who desired further pregnancy. We conclude that the medical approach to unruptured ectopic pregnancy is associated with a high rate of tubal patency and a reproductive performance similar to conservative surgical methods.     

Gamete intra-fallopian transfer in non-endometriotic pelvic adhesions

This report presents our experience with gamete intra-Fallopian transfer (GIFT) in cases with non-endometriotic pelvic adhesions. Two-hundred-and-eight GIFT attempts, where pelvic adhesions were identified laparoscopically in patients with no previous history of endometriosis, were subdivided into two groups: (i) post-surgical (n = 134) and (ii) non-surgical (n = 74). The extent of the adhesions was further classified according to the American Fertility Society (AFS) classification system. The overall clinical pregnancy rate was 39.4% (82 out of 208 attempts). There was no significant difference in the clinical pregnancy rate per attempt between the surgical (38.8%) and the non-surgical (40.5%) groups. A gradual, but not significant decline in the pregnancy rate was noticed from adhesion Stages I to III, but Stage IV had a significantly lower pregnancy rate (22.7%) than Stage I (47.4%). The intra-uterine pregnancy rate was observed to be higher, but not significantly, in the non-surgical (37.8%) than in the surgical (29.1%) cases. The overall ectopic pregnancy rate was 7.2% per attempt and 18.3% per clinical pregnancy. In the post-surgical group, the ectopic pregnancy rate per pregnancy was 3.5 times that in the non-surgical (23.2% versus 6.5%, respectively), and it was significantly higher in Stage IV (40%; two out of five pregnancies) than in Stage I adhesions (11.1%; three out of 27 pregnancies). In cases with a history of tubal surgery, the ectopic pregnancy rate was 33.3% (10 out of 30 pregnancies). Our results indicate that GIFT can offer a successful treatment option for selected cases with non-endometriotic pelvic adhesions.     

A randomized controlled trial comparing medical and expectant management of first trimester miscarriage

BACKGROUND: We aimed to determine whether outpatient treatment of miscarriage with vaginal misoprostol is more effective than expectant management in reducing the need for surgical evacuation of retained products of conception (ERPC). METHODS: Of 131 eligible women with first trimester miscarriage, 104 agreed to randomization to either 600 microg misoprostol or placebo intravaginally. They were assessed the following day and administered a second dose of their allocated treatment if miscarriage was not complete. Those not successful after two doses were seen on day 7, and, if miscarriage was not complete, an ERPC was performed. RESULTS: The success rate of medical management was 88.5% (46/52) compared with 44.2% (23/52) for expectant management. There was no significant difference in success rate (100 versus 85.7%) in women treated with an incomplete miscarriage. Women with early pregnancy failure had a success rate of 87% with misoprostol compared with 29% with expectant management [odds ratio (OR) 15.96; 95% confidence interval (CI) 5.26, 48.37]. The complete miscarriage rate was achieved quicker in the medical group than the expectant group by day 1 (32.7 versus 5.8%) and by day 2 (73.1 versus 13.5%) of treatment. There were no differences in side-effects, bleeding duration, analgesia use, pain score and satisfaction with treatment. Women in the expectant group made more outpatient visits (5.06 versus 4.44%; OR = -0.62, 95% CI -1.04, -0.19). More women in the medical group (90.4 versus 73.1%; OR 1.26, 95% CI 1.05, 1.50) would elect the same treatment in the future. CONCLUSIONS: Medical management using 600 microg misoprostol vaginally is more effective than expectant management of early pregnancy failure. Misoprostol did not increase the side-effect profile and patient acceptability was superior to expectant management.     

Transvaginal intratubal methotrexate treatment of ectopic pregnancy. Report of 100 cases

Between November 1988 and December 1993,100 patients with acommon, unruptured ectopic pregnancy were treated with 1 mg/kginjection of intratubal methotrexate under transvaginal sonographiccontrol. Patients were not excluded from this series on thebasis of the size of the adnexal mass, the term of ectopic pregnancyor initial p-human chorionic gonadotrophin (HCG) concentrations.Patients were excluded following uncertain diagnosis, signsof a ruptured ectopic pregnancy, or a significant haemoperitoneumon ultrasound scans. The mean age of the patients was 29.5 years(range 20–41). The mean gestational age and initial HCGconcentration were 7.5 weeks (5–11) and 11 614 mlU/ml(192-105 000 respectively). Of the 100 patients, 22 (22%) hadan ectopic pregnancy with active cardiac activity. Completeresolution was obtained in 78 out of these 100 ectopic pregnancies.Of these, 66 patients (85%) needed only one intratubal methotrexateinjection, and 12 patients (15%) required a second i.m. methotrexateinjection of 1 mg/kg. In this study, local treatment with onesingle intratubal methotrexate injection was successful in only66% of patients. The mean resolution time for reduction of p-HCGconcentrations was 23.5 days (range 7-40). There was no statisticallysignificant correlation between initial (J-HCG concentrationsand outcomes after methotrexate treatment of ectopic pregnancyin our study. Where embryonal heart beats were observed, thesuccess rate of the procedure was 40.9% (nine out of 22 cases).In the absence of cardiac activity, or when ultrasound examinationshowed no embryo, the success rate achieved was 84.6% (66 outof 78 cases) (P < 0.01). In all, 34 patients were consideredto be incompletely cured after only one intratubal methotrexateinjection: 12 patients required a second i.m. injection, a stagnationof {i-HCG concentrations was observed in 15 patients, abdominalpain occurred in six patients, and one patient suffered tubalrupture with haemoperitoneum. A total of 22 patients requiredsecondary surgical managment (salpingectomy). No biochemicalor clinical side-effects of methotrexate treatment occurred.Tubal alteration ascribable to methotrexate injection occurredin one patient in our study. Out of 75 patients in this serieswho wished to conceive, 21 (28%) became pregnant within 1 yearwith the following outcomes: 11 pregnancies at term, three miscarriages,one induced abortion and six recurrent ectopic pregnancies (fouroccurred on the same side). Our findings suggest that treatmentof common unruptured ectopic pregnancy without prior selectionof patients, by a single intratubal methotrexate administrationwas associated with a 66% success rate. This was dependent onlyon the presence of embryonal heart beats and there was no correlationbetween the success rate and initial fi-HCG concentrations.Successful outcome after methotrexate administration for ectopicpregnancy could be perfected by way of an improved selectionof patients based on inactive embryonal hearts and absence ofa visualized embryo.     

The place of methotrexate in the management of interstitial pregnancy

Six patients with interstitial pregnancies were treated with systemic or local injections of methotrexate, 15 mg i.m. daily for 5 days, or 1 mg/kg for 1 day. One dose of folinic acid rescue (50 mg) was administered on the first day of the treatment course. Diagnosis of interstitial pregnancy was established either by laparoscopy or transvaginal ultrasound. Out of six patients, five had serial measurements of serum human chorionic gonadotrophin (HCG), progesterone (P) and 17 beta-oestradiol (E2) until either the ectopic pregnancy resolved or surgery was performed. For one patient operated on day 1 after medical treatment, no serial serum measurements were performed. Serum HCG became undetectable under medical treatment in only four of the six patients. Out of these four patients, three had an initial level of HCG less than 1000 mIU/ml. Two patients underwent surgery (salpingectomy) because either the level of serum HCG did not decrease after the course of methotrexate therapy or it was required the next day to stop haemorrhage. In these patients, the initial level of HCG at the time of diagnosis, was 5300 and 43,000 mIU/ml, respectively. In the four patients who received conservative medical treatment only, the next menstrual period occurred 20-46 days after the onset of methotrexate and was preceded by luteal activity. A control hysterosalpingography performed 2 months later showed that in the four patients who received medical treatment only, the Fallopian tube was patent, and three became pregnant within 1 year of the methotrexate therapy. One of two patients who failed to respond to medical treatment and required surgical treatment, became pregnant 6 months later.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of ectopic pregnancy: the new gynaecological dilemma

Recent diagnostic advances have resulted in earlier and moreconsistent diagnosis of ectopic pregnancy. This may be responsible,in part, for the increasing incidence of the condition. Also,early diagnosis of ectopic pregnancies has prompted conservativesurgical treatment, the use of medical therapy and even expectantmanagement in selected cases. The present article analyses thefollowing main controversial questions concerning the managementof ectopic pregnancy: whether to treat or not, and how to applyexpectant management; whether therapy should be conservativeor radical; whether conservative management should be surgicalor medical; whether surgical intervention should be laparotomicor laparoscopic; and whether medical therapy should be systemicor local     

Microlaparoscopy for an intact ectopic pregnancy and endometriosis with the use of a diode laser: case report

Microlaparoscopy is a development of endoscopic surgery which further reduces invasiveness of surgical procedures. The use of a diode laser in microlaparoscopy for the treatment of a patient with an intact ectopic pregnancy and endometriosis is described for the first time. As the diode laser has easy management and widely recognized precision, its use could be highly advantageous in such situations. The success achieved in this case contributes to the wider use of micro-endoscopic procedures.     

Uterine artery embolization for management of interstitial twin ectopic pregnancy: case report

Interstitial pregnancy is rare and dangerous variation of ectopic pregnancy. We describe a case of unilateral interstitial viable twin pregnancy treated by selective uterine artery embolization. A 23-year-old women with clinical and ultrasonic diagnosis of viable twin interstitial pregnancy was treated by selective uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-HCG was undetectable 2 months after the procedure and the ultrasound scan 70 days after embolization showed only multiple echogenic spots in the right uterine cornua. This therapeutic modality seems to be effective for conservative management of interstitial ectopic pregnancy, and as a prophylactic measure before surgical intervention to prevent major bleeding.     

A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy

BACKGROUND: Currently, the likely success of single-dose methotrexate (MTX) (50 mg/m(2)) for the treatment of ectopic pregnancy is indicated by a >15% decrease in hCG from days 4-7 after administration. The aim of this study was to assess this protocol and to develop new rules that could be used to predict the outcome at an earlier stage. METHODS: Data were collected prospectively. Women receiving MTX for an ectopic pregnancy had serum hCG and progesterone levels checked on days 1, 3, 4, 5 and 7. Other factors including age, gestational age, previous obstetric history and ultrasound findings were recorded. The women were followed up until the outcome of medical management was known. Univariate analysis was performed to determine the benefit of the '15% day 4-7 rule', as well as to develop new rules, which potentially could be used to predict the likelihood of success before 7 days. Historical and ultrasound variables were also analysed to identify the significant variables associated with successful conservative management. RESULTS: The success rate of single-dose MTX was 68.1% (47/69). A second dose was required in 18.8% (13/69) of cases, and it was successful in 84.6% (11/13). The 15% day 4-7 rule correctly predicted the outcome in 90.3% of cases [sensitivity 93.0%, specificity 84.2%, positive predictive value (PPV) 93.0% and negative predictive value (NPV) 84.2%, Fisher exact test P-value < 0.0001]. New rules were developed based on the percentage change day 4-5 and logistic regression models incorporating day 5 hCG levels and ultrasound findings. These new rules did not outperform the current 15% day 4-7 rule. CONCLUSIONS: We have confirmed that a 15% decrease in serum hCG between day 4 and day 7 is a very good indicator of the likely success of MTX. The development of new rules did not significantly improve our ability to predict a successful outcome at an earlier stage.     

Hormone and ultrasound parameters in ovarian stimulation cycles for direct intraperitoneal insemination.

To determine hormonal and ultrasound parameters associated with pregnancies, 115 women with unexplained infertility (n = 82), endometriosis (n = 22) or cervical factor (n = 11) were treated with direct intraperitoneal insemination (DIPI) after ovarian stimulation with clomiphene citrate and human menopausal gonadotrophins (HMG). Twenty women conceived and were compared with the remaining 95 non-pregnant women during one treatment cycle. Women with basal FSH levels less than or equal to 1.25 micrograms/l responded with higher oestradiol levels (P less than 0.0001), with the development of more follicles (P less than 0.05) and higher progesterone levels (P less than 0.05) than women with basal FSH levels greater than 1.25 micrograms/l, but the conception rates were similar. Women with miscarriages or biochemical pregnancies had a higher basal FSH value than both the women with term pregnancies and the non-pregnant women. Women with at least 3 preovulatory follicles greater than or equal to 15 mm had a higher pregnancy rate than those with fewer follicles, but a further increase was not observed above that number. The endometrium was thicker on the day of ovulation induction in cycles leading to a term pregnancy than in cycles without conception or with a biochemical pregnancy. No term pregnancy was observed when the endometrium was thinner than 8 mm. Women with a short luteal phase (less than 12 days) had a higher ratio of oestradiol/progesterone in the midluteal phase than women with a luteal phase of greater than or equal to 12 days and pregnant women.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pregnancy: Operative laparoscopy for ectopic pregnancy: how experienced should the surgeon be?

The purpose of this study was to assess the efficacy of laparoscopicsurgery for ectopic pregnancy in a general hospital in Paris,where most of the surgeons are still in training. During a periodof 20 months, 100 cases of ectopic pregnancy were diagnosedand treated by the attending residents. Nine cases requireda laparotomy due to heavy bleeding or interstitial ectopic pregnancy.Most of the other cases were treated laparoscopically, witheither salpingectomy (70 cases) or linear salpingostomy (19cases). Complications of the laparoscopic surgical procedureswere rare. There was one failure of linear salpingostomy thatrequired a second intervention (5.3% failure rate); there wasone case of urinary retention that resolved after 48 h; andone case of fever above 38°C that responded well to antimicrobialtherapy. In conclusion, we have shown that the current notionthat laparoscopic surgery is preferred to conventional abdominalsurgery for the treatment of ectopic pregnancy, can be appliedto a public gynaecological centre with young inexperienced residents,supervised by experienced gynaecologists.     

血β-HCG监测118例异位妊娠保守治疗的临床意义

为探讨血清p-HCG（人绒毛膜促性腺激素）检测在异位妊娠保守治疗中的临床价值,选择确诊的异位妊娠患者118例（药物保守治疗者72例,手术治疗者46例）,测定其血清β-HCG值并进行对照分析。结果显示,能用药物保守治疗且成功者其血清β-HCG含量全部〈200ml U／mL,而需手术治疗者血清β-HCG含量〈200ml U／mL者仅占26．3％,两者有显著差异（P〈0．01）。这提示血清β-HCG值的监测对异位妊娠的诊断、治疗措施的选择及保守治疗效果的判断有重要的临床价值,在治疗异位妊娠过程中,血清β-HCG是判定治疗成败与否的良好标志物。     

A comparative study of surgical and medical procedures: 932 pregnancy terminations up to 63 days gestation

The aim of this retrospective study was to compare the efficacy and complications associated with early medical and surgical pregnancy termination. The study population comprised 932 consecutive women undergoing pregnancy termination at gestations of 63 days or less. There were no age or parity differences between the study groups. Medical termination was performed with mifepristone 200 mg orally and misoprostol 800 microgram vaginally; surgical aspiration termination was performed under general anaesthesia. Outcome measures were: surgical curettage for presumed retained products of conception; ongoing pregnancy; and planned and emergency review in the unit. Early medical and surgical termination were associated with a 90.2 and 94.5% complete abortion rate respectively (P = 0.025). The complete abortion rate with medical termination decreased significantly with increasing parity; no such relationship with surgical abortion was found. Women of parity three or more were less likely to have a complete abortion following a medical (83.3%) compared to surgical procedure (97.7%) (P = 0.028). The ongoing pregnancy rate was 0.9% with medical and 0.5% with surgical termination (P = NS). Medical termination was associated with a lower complete abortion rate than surgical termination, particularly for women of higher parity. However, early medical termination allows over 90% of women to avoid the risks of surgical instrumentation of the uterus and anaesthesia.     

A review of 254 ectopic pregnancies in a teaching hospital in the Trent Region, 1977-1990.

A total of 254 cases of ectopic pregnancy were reviewed in a teaching hospital in Sheffield, in three defined periods: I, 1977-9; II, 1985-7 and III, 1988-90. A previous history of infertility was noted in 37% of cases. Overall, the presenting symptoms, clinical, laboratory, operative as well as histological findings, are in broad agreement with other series. The incidence increased steadily from 8.6 per 1000 total births in period I to 16.5 per 1000 total births in period III. A number of changes noted in recent years include: (1) the diagnosis of ectopic pregnancy was made significantly (P less than 0.05) earlier; (2) a significantly (P less than 0.05) greater proportion of ectopic pregnancies had an association with the following factors: previous tubal surgery, the diagnosis established with ultrasonography, laparotomy preceded by laparoscopy and treatment by conservative surgery; and (3) a significantly (P less than 0.05) smaller proportion of ectopic pregnancies had the diagnosis based on pelvic tenderness or pelvic mass. During the period 1988-90 a total of 126 laparoscopies were performed for suspected ectopic pregnancy, of which 82 (65%) were confirmed to have ectopic pregnancy and 44 (35%) were thought to have no evidence of ectopic pregnancy on laparoscopy. However, two of the latter cases were subsequently found to have an ectopic pregnancy within 2 weeks. The clinical implications of these findings are discussed.     

Pregnancy: Determinants of reproductive prognosis after ectopic pregnancy

The reproductive prognosis of 115 women desiring pregnancy whounderwent surgery for ectopic pregnancy between 1985 and 1990at the Clinica Luigi Mangiagalli, was analysed after a medianfollow-up period of 26 months (range 2–83). Probabilityof reproductive events was assessed by a product-limit model.Women who underwent surgery for ectopic pregnancy had a 54%probability of becoming pregnant (cumulative pregnancy rate,CPR) and a 36% probability of giving birth to a child (cumulativelivebirth rate, CLB) during the 3 years after surgery. Thesepercentages dropped with history of previous ectopic pregnancy(respectively 33%, P = 0.07, and 7%, P < 0.05). Increasingage at surgery and presence of adhesions in the contra-lateraltube seemed to be associated with poor reproductive prognosis(CPR = 40% and CLB = 12% for women aged 35 years and CPR = 37%and CLB = 20% in women with adhesions in the contra-lateraltube), but these findings were not statistically significant.No association emerged between fertility and parity or typeof surgery. The recurrence rate of ectopic pregnancy was 20%.No significant association emerged between recurrence of ectopicpregnancy and age, history of previous pregnancy, history ofprevious ectopic pregnancy, non-intact contra-lateral tube andsalpingotomy.     

The probability of multiple births when multiple gestational sacs or viable embryos are diagnosed at first trimester ultrasound

The live birth outcome when multiple gestational sacs were diagnosed at first trimester ultrasound was reviewed in 227 twin, 43 triplet and five quadruplet pregnancies. When two gestational sacs were present, the probability of delivering twins was 63% for maternal age less than 30 and 52% for maternal age greater than or equal to 30. With three gestational sacs, the probability of a triplet birth was 45% for maternal age less than 30 and 18% for maternal age greater than or equal to 30. When two viable embryos were present, the probability of a twin birth was 90% for maternal age less than 30 and 84% for maternal age greater than or equal to 30. With three viable embryos, the probability of a triplet birth was 90% for maternal age less than 30 and 44% for maternal age greater than or equal to 30. Two gestations resulting from ovulation induction with clomiphene citrate were more likely to result in twin delivery at term, compared to spontaneous twin gestations (P = 0.012). These findings may be useful in the treatment and management of patients when multiple gestations are diagnosed early in pregnancy.     

Medical management of early fetal demise using a combination of mifepristone and misoprostol

BACKGROUND: This study aims to assess the efficacy of a combination of mifepristone and misoprostol in the management of missed miscarriage and anembryonic pregnancy. METHODS: Data of 220 consecutive women with miscarriage, undergoing medical evacuation of the uterus were collected prospectively at an early pregnancy assessment unit in a tertiary referral hospital. Each woman received a single oral dose of mifepristone 200 mg and 36-48 h later vaginal misoprostol 800 microg. Three hours following the first dose, two further doses of misoprostol, 400 microg each, were administered vaginally or orally at 3 h intervals. Women who failed to pass products of conception were offered repeat medical regime with misoprostol. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation. RESULTS: The overall success rate of medical management was 84.1%. Mifepristone alone induced natural expulsion of products of conception in 18.1% of women. The median dose of misoprostol required was 1600 microg and the median induction miscarriage interval after first prostaglandin administration was 8.04 h (range: 0.58-50.54 h). Of the 142 women who were symptomatic at presentation the medical regime failed in 30 (21.1%), compared with five (6.4%) failures of the 78 who were asymptomatic (P = 0.007). Of the 35 women who had surgical evacuation, eight required an emergency curettage for bleeding. CONCLUSIONS: The combination of oral mifepristone 200 mg with vaginal or oral misoprostol is an alternative to surgical management of early fetal demise, although it is not as effective as surgery.     

肱骨中下段骨折手术与非手术治疗的比较分析

目的比较肱骨中下段骨折手术和非手术治疗的效果。方法自2007年6月~2009年8月采用手术和非手术的方法治疗40例新鲜无桡神经损伤的肱骨中下段骨折病人,其中手术组22例,非手术组18例。结果手术组中发生桡神经损伤4例,骨不愈合2例;非手术组中发生桡神经损伤1例,骨不愈合1例,畸形愈合3例。2组桡神经损伤发生率、骨折愈合时间比较差异有统计学意义(<0.1);而骨不连发生率、骨折愈合率和终末随访时肘关节Mayo评分2组比较差异无统计学意义(>0.05)。结论非手术治疗肱骨中下段骨折在骨折愈合时间和预防医源性桡神经损伤方面优于手术治疗。     

紧急避孕后异位妊娠33例分析

目的探讨口服紧急避孕药与异位妊娠的相关性。方法对我院2006～2008年收治口服紧急避孕药后异位妊娠患者33例进行了回顾性分析与总结。结果 33例异位妊娠中服用左炔诺孕酮30例,服用米非司酮3例。异位妊娠流产型居多,占69.70%,非手术治疗治愈率达到51.52%。结论异位妊娠的发生可能与服用紧急避孕药后输卵管功能障碍,导致胚胎异常植入有关;非手术治疗治愈率较高可能与异位妊娠流产型居多相关;口服紧急避孕药后应重视阴道流血症状,警惕异位妊娠,防止误诊误治。