| The incidence of ectopic pregnancy, the common emergency gynecology,accounts for1-2%of all pregnancies, and95%occours in the fallopian tube.Though the main therapy for ectopic tubal pregnancy is surgery, the MTXregimen is widely used. and accept90%success rate.The choice of MTX asthe first-line therapy increased over years and accepted about90%successrate,which benefited from the improvement of the testing technic, suchas:serum β-hCG、 TVS et al. All the advanced technics make ectopicpregnancy diagnosed erlier, and make the conservative therapy possible.MTX,the folic acid antogonist, is widely used as the medical treatment forectopic pregnancy conservative therapy. There are several MTXregimens,such as single-dose、two-dose、multi-dose, which are named forthe intended number of doses, rather than the actual number of doses given.Compared with the two-dose and multi-dose regimen, the single-dose regimenget similar success rate and less side effects.Objective： All the330women whose data was complete and visit wasavainable,were diagnosed with ectopic tubal pregnancy and treated withsingle-dose MTX intramuscular administration. The purpose of this study wasto evaluate the efficacy of the single-dose regimen and guide the clinicalpractice.Methods: A retrospective review of the330inpatients who were diagnosedwith ectopic tubal pregnancy during2008and2012and treated with MTXsingle-dose regimen was performed. They are divided into two groups:casesmanaged successfully without surgery and cases required surgery(failure).Results:The number of EP patients increased but the incidence was stableduring2008and2012. The total success rate was67.9%(224/330),but thesuccess rate reached85.44%when the initial β-hCG titer was less than 1000mIU/ml. The patients’ ages varied from18to43,and there’s nosignificant different between the two groups （P＞0.05）.Ninty patientscomed the first pregnancy.Seven patients were secondary to the IVF-ET.Seventeen patients were diagnosed with EP wearing IUD.The diameter ofthe ectopic mass varied from0.83cm to6.98cm,and there’s no significantdifference between the two groups（P＞0.05）.Only259patients had justone injection of MTX,67patients got two,and4patients got three.Theanalysis turns out that the times of injection given has no relationship with theinitial β-hCG titer，but the diameter of the ectopic mass affects the injectiontimes.The initialβ-hCG titer varied from33.06-59350mIU/ml,and the medianvalue was３０.６１mIU/ml.The initial β-hCG level in the failure group ishigher than that in the success group （'４４３vs.３０５.５９, P=0.00）,and the same as the4th day after the first dose of MTX （'３７３.５vs.１６'.'，P=0.00）,which are statistically significantly different. Thesuccess rate increases when the decrease in β-hCG level after one MTX dosediffered statistically significantly.The receiver operating characteristic (ROC)curve cut-off value in the success group indicates a drop rate of31.68%(sensitivity0.589,specificity0.821) on the the fourth day.Conclusion:There’s a large width of serum β-hCG titer in the study.The totalsuccess rate is67.9%,and it reachs85.44%when the initialβ-hCG titer is lessthan1000mIU/ml.We should detect the serum β－ｈＣＧ on the fourth daywhen the medical management with MTX is performed. The failure rateincreases when the fourth day’s β-hCG level decreases less than31.68%(sensitivity0.589,specificity0.821) compared with the initial level.TheMTX management is safe and efficient.Patients should be advised to tryconservative regimen for MTX only when they are hemodynamically stable. |
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