| Objective: To analyse the clinical materials of ectopicpregnancy with medical-conservative management, discussthe nonsurgical diagnostic of the ectopic pregnancy,theconjunction use of methotrexate(MTX),Mifepristone,Chinese traditional medicine and the predictors ofsuccess of treatment.Methods: We conducted a retrospective review of 44 ectopicpregnancy of Nanshan hospital with medical-conservativemanagement between 2004.3 ～2004.9 using nonsurgicaldiagnostic. Women with a serum human chorionicgonadotropin (hCG)concentration of less than2.9mIU/ml,at the same time no intrauterine gestationalsac was traced by transvaginalultrasonography(TVUS),accompanied by an abnormal rise ofserum β-hCG concentration(<66% rise in 48hours),can bediagnosed ectopic pregnancy. Women receivedintramuscular MTX at a dose of 50mg/m2 of body surfacearea .The day on which MTX was injected was considered tobe day "one", on the second day Mifepristone 300mg wasgiven, consequently the Chinese traditional medicine wasgiven in order to promote the absorber of the adnexal massand the peritoneal fluid. Serumβ-hCG measurement wereperformed on Monday,Wednesday and Friday, until theconcentration reached 2.9mIU/ml.Results: The mean(±SE) age of 40 women is 28.4±5.5 yearsand the range of the age is 19-40 years. 31(77.5%) havethe risk factors of ectopic pregnancy. The classic triadis abdominal pain and vaginal bleeding. Of the 44 womenin the study, Total of women were diagnosed by TVUS andserial β-hCG measurements not less than 2 times. Of the40 women, the mean concentration of the initialβ-hCG was5390 ±13629mIU/ml ,TVUS revealed an ectopic mass in30(75%), a fetal cardiac activity in 1(2.5%)and freeperitoneal fluid, confined to the pelvis, was found in20(45.5%). 36 (90%)women were successfully treated with MTX,4(10%) performed surgical intervention for presumed tubalrupture suspected. The women treated successfully andunsuccessfully did regard to the mean serumβ-hCG. It isrevealed a high serumβ-hCG concentration to be the onlyfactor significantly linked to the failure oftreatment(P<0.001).When initialβ-hCG level were loweror higher than 10000 mIU/ml, the success rate was 94% and50%,respectively(P=0.04).It revealed that the initialβ-hCG at 10000 mIU/ml was the critical level formedical-conservative management, while higher than thecritical level may result a high failure rate. The classical triad for the patient who presents withectopic pregnancy is amenorrhea, abdominalpain, andvaginal bleeding. Unfortunately, these findings arenonspecific, these happen more often in threatenedmiscarriage than in ectopic pregnancy. Beta-hCG is producted by the trophoblasts and may bedetectable in the serum as early as 1 weekly beforeexpected menses. Normal dynamics forβ-hCG are that itdoubles approximately every 1.4 to 2.1 days until it peaksabove 100000 mIU/ml. This doubling rate slows somewhatafter reaching 10000 mIU/ml. We diagnose 40 ectopic pregnancy successfully byemploying serial β-hCG testing in conjunction withultrasonography in our study. The only true ultrasonicfinding diagnostic of an ectopic pregnancy isvisualization of a gestational sac with fetal pole outsidethe endometrial cavity. Cacciatore et al prospectivelytested 200 pregnant women suspected of having an ectopicpregnancy pregnancy with TVUS and β-hCG measurements.They found that all women with a β-hCG level greater than1000 mIU/ml and an empty uterus had confirmed ectopicpregnancy pregnancy (specificity 100%, positivepredictive value 100%, sensitivity 67%). Cacciatore found that a complex adnexal mass orgestational saclike adnexal ring separate from the ovaryis highly suggestive of ectopic pregnancy with asensitivity of 93%,specificity of 99%, and positivepredictive value (PPV) of 98%. Neberg also found thatcharacterizing the amount and appearance of pelvic fluidis helpful diagnostically. The presence of a moderate tolarge amount of fluid in the cul-de-sac or the presenceof any echogenic fluid had 96% specificity for diagnosingectopic pregnancy. Success rates with single-dose MTX are promising,ranging from 63%-94%. Success rates, tubal patency rates,and subsequent fertility rates have been found to beequivalent to those following surgical therapy. In ourstudy, we got a success rate of 90% in our study formedical-conservative management for ectopic pregnancy bythe conjunction use of methotrexate(MTX),Mifepristone,Chinese traditional medicine, which is good. The threekinds of medical did not destroy fallopian tube and givepatients the hope of conserving the fecundity. The most studies prognostic factor has been the serumβ-hCG concentration. A serumβ-hCG above 10000 mIU/mlwas a risk factor for treatment failure, which is same tous. All previously published protocols for systemicmethotrexate treatment of women with ectopic pregnancieshave restricted treatment to women with a gestational massless than 3-4cm in size. In our study the size of the masswere not restricted, so the range of choosing the patientswas more wider than before, and the success rates, tubalpatency rates were also rising than before. The presenceof fetal cardiac activity has also been considered arelative contraindication to MTX therapy. In our study,1 patient with fetal cardiac was successful by receivingtwo dose MTX. But the result that fetal cardiac did notaffect the success rates were not given. The presence of free peritoneal fluid is consideredby many to be a contraindication to MTX therapy. In ourstudy, of the 20 patients with free peritoneal, only 2 havetubal rupture. In our study of 40 patients, 16 patients have arisingof liver enzyme, and became natural by medical therapy.No patient has possible side effect, same to the study... |
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