甲氨蝶呤联合米非司酮与中药宫外孕I号方治疗异位妊娠疗效的对比观察

目的观察比较甲氨蝶呤（MTX）联合米非司酮与配伍中药治疗有生育要求且未破裂型异位妊娠的临床疗效。方法：把入选的126例患者随机分为A、B两组,A组采用MTX联合米非司酮杀胚,B组采用MTX配伍中药保守治疗,比较两组临床疗效。结果在血β-HCG水平降至正常,治愈的时间及包块消失时间等方面比较,A组显著优于B组（P〈0．05）。而在治愈率、输卵管再通率、妊娠成功率等方面比较,两组差异无统计学意义（P〉0．05）。结论：MTX联合米非司酮可以缩短患者住院时间,见效快,值得临床推广。     

米非司酮联合甲氨蝶呤治疗异位妊娠

目的 探讨米非司酮联合甲氨蝶呤治疗异位妊娠的效果。方法 78例输卵管妊娠患者随机分为A、B两组，A组42例给予米非司酮，3次／d，口服，每次50mg，连续3天，同时给予甲氨蝶呤60mg一次性肌肉注射。B组36例，给予甲氨蝶呤60mg一次性肌肉注射。定期检测血β—HCG、血常规、肝、肾、凝血功能、B超。结果 米非司酮联合甲氨蝶呤治疗异位妊娠成功率为88．09％，明显高于对照组。治疗效果与用药方案及治疗前血β—HCG水平有关。结论 米非司酮联合甲氨蝶呤治疗异位妊娠安全有效，早期诊断、严格掌握适应证是治疗成功的关键。     

Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy

OBJECTIVE: To investigate whether a history of previous ectopic pregnancy is an independent risk factor for failure of methotrexate therapy in subsequent ectopic pregnancies and whether the previous treatment method influenced failure. SETTING: Inner-city teaching hospital. DESIGN: Retrospective case review. PATIENT(S): Five hundred four consecutive patients treated with "single-dose" methotrexate for ectopic pregnancy. Nine patients electing surgery after beginning medical therapy were excluded from analysis. INTERVENTION(S): Systemic methotrexate 50 mg/m(2). MAIN OUTCOME MEASURE(S): Failure of methotrexate therapy. RESULT(S): Twenty-one (18.6%) of 113 of previous ectopic patients and 26 (6.8%) of 382 first-time ectopic patients failed methotrexate therapy (odds ratio, 3.12). The overall success rate was 90.5% (448/495 patients). Univariant analysis showed that treatment hCG and progesterone (P) levels and ectopic cardiac activity were significantly different between successful and failed therapy. Logistic regression analysis for these four variables showed that only hCG and history of previous methotrexate remained significant risk factors for failure of methotrexate therapy. The likelihood of failure in patients with a previous ectopic was not influenced by previous treatment with salpingostomy, salpingectomy, or medical treatment. CONCLUSION(S): A history of previous ectopic pregnancy appears to be an independent risk factor for failure of systemic methotrexate treatment, but failure is not affected by previous treatment method.     

Cervical ectopic pregnancy: surgical or medical treatment?

Cervical pregnancies are one of the rarest forms of ectopic gestations. The incidence of cervical ectopic pregnancies ranges between 1 in 1,000 to 95,000 gestations (Parente et al., Obstet Gynecol 62:79–82, 1983). Prior surgical trauma, including dilatation and curettage of the cervix, has been identified as one of the leading risk factors (Pisarska et al., Lancet 351:1115–1120, 1998; Yankowitz et al., Obstet Gynecol Surv 45:405–414, 1990). Cervical ectopic pregnancies are especially feared due to their associated life-threatening hemorrhage. Therefore, massive blood transfusions and emergency hysterectomy have often been required previously. Nevertheless, general guidelines for clinical management are lacking. In case reports medical and surgical treatment modalities are described. Overall, conservative management of an asymptomatic cervical ectopic pregnancy using methotrexate or potassium chloride seems to be superior to surgical intervention. The treatment of choice in patients suffering from symptomatic cervical ectopic pregnancy is still under discussion. In the case reported here, a combination of surgical and medical treatment conserving the patient’s childbearing capacity was successfully implemented. However, severe hemorrhage occurred and consecutive blood transfusions were urgently necessary. Emergency hysterectomy could be avoided.     

Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound-guided aspiration and single-dose methotrexate

OBJECTIVE: To present a case of cervical ectopic pregnancy successfully treated with ultrasound-guided aspiration and single-dose methotrexate administered systemically. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old nulliparous woman with a cervical ectopic pregnancy. INTERVENTION(S): Transvaginal ultrasound-guided aspiration of the cervical ectopic pregnancy followed by single-dose methotrexate administered systemically. MAIN OUTCOME MEASURE(S): Recovery of the patient, successful conservative treatment of the cervical ectopic pregnancy, with preservation of the uterus. RESULT(S): The cervical ectopic pregnancy was successfully aborted, and the reproductive capability of the patient was preserved. CONCLUSION(S): Transvaginal ultrasound-guided aspiration in combination with single-dose methotrexate administered systemically can be safely used to treat cervical ectopic pregnancies.     

Transverse myelitis following methotrexate treatment of ectopic pregnancy: a case report

Objective: Ectopic pregnancy is a common condition in the field of gynaecology, often treated with methotrexate. Adverse effects are common and usually mild. Severe adverse events are rare amongst patients treated with MTX for this condition.

Case: A 26-year-old healthy woman was admitted and treated medically with MTX for an ectopic pregnancy. The patient was treated in the standard drug labelled protocol with an intramuscular injection of 78?mg of MTX according to body surface area. Soon after, the patient presented to the emergency department with symptoms of bilateral paresthesia of the lower limbs which ascended to the pelvis. After a thorough work up and imaging via MRI a diagnosis of transverse myelitis was made. Treatment was successful with corticosteroids and symptoms subsided.

Conclusions: We propose that MTX should be used with caution and severe toxicity should be kept in mind with high index of awareness for any symptom development following treatment, especially neurological one.     

Single dose methotrexate therapy: application to interstitial ectopic pregnancy

A woman with a small (6-mm gestational sac) interstitial pregnancy had complete resolution after medical therapy alone. A single cycle of methotrexate 50 mg/m² was used as outpatient treatment without any operative procedure either for diagnosis or intervention. The guidelines that have evolved for selection of women for single dose methotrexate treatment for both intrauterine and tubal ectopic pregnancies may be applicable to interstitial ectopic pregnancy as well. A suggested framework for treatment decisions is presented.     

Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies

Interstitial ectopic pregnancy is a term loosely used in the literature to describe three different entities. The first is the true interstitial ectopic pregnancy, which occurs in the interstitial or intramural segment of the Fallopian tubes. The term cornual ectopic pregnancy should be reserved for pregnancy in women with a single uterine horn, a bicornuate uterus, or a septate uterus. Angular pregnancy is a term that is rarely used and should be limited to a pregnancy in one of the angles of the uterus, but not inside the Fallopian tube.Historically, interstitial pregnancy was considered safe to manage conservatively until over 12 weeks because of the delayed risk of rupture as a result of the protection offered by the muscle of the uterus. However, over the last decade evidence now suggests that early rupture is not uncommon. The management of an interstitial pregnancy should be ascertained by ultrasonography, particularly three-dimensional ultrasonography. Depending on the size and viability of the pregnancy, management should be planned accordingly. Laparoscopic management is ideal for surgeons comfortable with the principles of laparoscopic surgery and suturing. However, laparotomy is a suitable alternative that will always provide a safe outcome. Adequate suturing of uterine cornua could prevent the risk of rupture during subsequent pregnancies. Minimizing blood loss during and after surgery is a priority.     

甲氨蝶呤和米非司酮联合治疗非破裂型输卵管妊娠

目的探讨甲氨蝶呤(MTX)和米非司酮联合治疗非破裂型输卵管妊娠的效果。方法米非司酮300mg一次顿服,MTX20mg静注×5d。单用MTX的病人设为对照组。结果MTX和米非司酮联合治疗的成功率为87.5％,明显高于对照组。观察治疗期间病情变化,发现疗效与血β-hCG高低及有无心管搏动有关。结论MTX和米非司酮联合治疗非破裂型输卵管妊娠安全有效,适用于生命体征平稳、无剧烈腹痛、无心管搏动及血β-hCG＜30μg/L的非破裂型输卵管妊娠。     

Treatment of a cervical viable pregnancy with a single intraamniotic methotrexate injection: a case report

Introduction. Cervical pregnancy is a rare condition, constituting <1% of all ectopic pregnancies. Case report. We report here, the successful management of a viable 7 weeks gestation cervical pregnancy. Feticide with 2 ml of potassium chloride 15% was performed under the guidance of transvaginal ultrasonography. Then 70 mg methotrexate (50 mg/m²) was injected through this spinal needle in to the amniotic cavity. Also serial changes in the color Doppler imaging after the methotrexate injection were emphasized.     

Single-dose methotrexate for the treatment of unruptured ectopic pregnancy

Objective The objective of this study was to review our experience with single dose intramuscular methotrexate (MTX) for the treatment of ectopic pregnancy and to evaluate major confounding factors that relate to the success of therapy.Patients and methods The selection criteria were patients who had a stable hemodynamic status and an ectopic gestational mass of <4 cm. on ultrasound. Patients were not excluded from MTX therapy either by a baseline serum -hCG titer or by the presence of fetal cardiac activity demonstrated on ultrasonography. Thirty- four of 86 patients diagnosed with ectopic pregnancy and treated with single-dose MTX between July 1999 and November 2001 were reviewed retrospectively.Results The mean pre-treatment -hCG level was 2,490±2,912 mIU/ml. Twenty-two patients (73.3%) were successfully treated with a single-dose of MTX. Eight patients (26.6%) required a second dose 1 week after the first injection and 2 patients received three doses. Thirty of the 34 patients (88%) were successfully treated with MTX. The mean pre-treatment -hCG level was significantly lower in patients who were successfully treated with MTX than in patients who failed MTX therapy (1,932±2,361 mIU/ml vs. 6,955±2,690 mIU/ml respectively, p<0.05). The mean pre-treatment serum -hCG level was higher in patients who had a second MTX injection as compared to patients who were successfully treated with a single injection of MTX (3,272±3,551 mIU/ml vs. 1,280±2,273 mIU/ml respectively, p>0.05). The mean time to resolution of -hCG was 26.5 days (10 to 37 days) with MTX. All 3 patients who failed medical therapy had -hCG level >4,000 mIU/ml and 2 of them had positive fetal cardiac activity.Conclusion In conclusion, this study showed that medical treatment of ectopic pregnancy with systemic single-dose methotrexate seems to be an option for some patients with unruptured tubal pregnancy.     

米非司酮治疗异位妊娠后宫内再孕率分析

目的　探讨米非司酮 (RU4 86 )治疗异位妊娠成功后的宫内再孕率。方法　回顾性分析我院1 996年 1月～ 2 0 0 2年 1月之间收治的 98例有生育要求的、药物保守治疗成功的异位妊娠患者的临床资料 ,其中5 8例为米非司酮 (RU4 86 )治疗成功 ,4 0例为甲氨蝶呤 (MTX)全身治疗成功 ,并经门诊及电话随诊。结果　RU4 86治疗者宫内再孕率 5 1 7% ,MTX治疗者宫内再孕率 5 2 5 % ,两者比较差异无显著性 (P >0 0 5 )。结论　RU4 86保守治疗的宫内再孕率和MTX保守治疗的宫内再孕率比较无明显差异 ,而且前者无明显副作用 ,血 β -hCG下降明显 ,患者更易接受     

Spontaneous bilateral tubal ectopic pregnancy and failed methotrexate therapy: A case report

Spontaneous bilateral ectopic pregnancy is extremely rare. An unsuspected case of spontaneous bilateral ectopic pregnancy with failure of single-dose methotrexate is presented. We question whether the recommended dose of methotrexate for unilateral ectopic pregnancy is adequate for bilateral tubal pregnancy.(Am J Obstet Gynecol 1997;177:1545-6.)