异位妊娠MTX保守治疗过程中破裂出血病例的临床分析

目的:评价异位妊娠在MTX保守治疗过程中发生破裂出血的危险因素。方法:回顾性分析100例MTX保守治疗的异位妊娠妇女,主要测量指标为血浆HCG水平。结果:异位妊娠MTX保守治疗前、后HCG水平的上升速度与输卵管破裂出血密切相关;保守治疗给药前48 h HCG上升超过66%或给药后HCG仍持续性升高,则提示输卵管破裂可能性大;65%异位妊娠破裂出血在峡部。结论:MTX治疗前、后HCG上升的速度是预示输卵管破裂出血的良好指标;保守治疗给药前HCG上升速度超过66%/48 h或用药后HCG仍持续性升高,提示可能需要外科手术治疗;妊娠囊的着床部位也是输卵管破裂的高危因素。

Clinical analysis of tubal rupture among ectopic pregnancy treated with methotrexate

Objective:To identify risk factors for tubal rupture among ectopic pregnancy treated with methotrexate(MTX).Methods:Retrospective case-control analysis of one hundred women diagnosed with an ectopic gestation treated with MTX:20 patients experienced subsequent tubal rupture,and 70 patients experienced ectopic resolution.Results:The HCG incremental rate before as well as after MTX administration was positively associated with tubal rupture.HCG values prior to ectopic diagnosis that increased at least 66% over 48 hours and rising hCG values after treatment with MTX were independent predictors of tubal rupture.A disproportionate number(65%) of ectopic pregnancies that ruptured were located in the tubal isthmus.Conclusion:The HCG incremental rate both before and after MTX represents an independent risk factor for subsequent tubal rupture.Concentrations of HCG before ectopic diagnosis that increased at least 66% over 48 hours, or persistently rising HCG concentrations after treatment with MTX,may lower the threshold for surgical intervention.Implantation site may represent an unidentifiable risk factor for tubal rupture.