Conservative Medical Treatment Of Unruptured Tubal Pregnancy-Clinical Report Of One Case

The patient was a 25-year oldmarried woman complaining of "amenorrhea for fifty one days along with slight distending pain in hypogastrium for six days".The patient had an inregular menstrual cycle before.The last menstrual period (LMP) was 2002.7.2. Menstruation of August did not come until 8.16th,when irregular dark red vaginal bleeding occurred with slight distending pain in hypogastrium. ;On 8 22th, Urine pregnancy test was positive,serum hCG level was 3410.2mIU/ml.Transabdominal sonography indetified the absence of an intrauterine sac as well as a left adnexal mass with size of 2.9 X 1.4 X 2.9cm3 within which the sign of 'duble ring' was not clearly seen, .The sufferer complained of slight distending pain in hypogastrim, but no dizziness, fainting and urge to defecate.Past history:Vaginitiis,annexitis treated by medicine but without satisfactory clinical result The suffer denide history of operation,trauma or allergic reaction to drugs such as penicillin.Menstrual history and obstetric history:Menarch in 14,7/30.the volume and colour of menstruation was normal but menstrual cycle was usually delyed for one to two weeks.There was no dysmenorrhea,but the volume of the leukohea was large and the colour was yellow.G3PO,she had artificial abortion twice and medical abortion once.Individual and family history:She was born in Wuhan and lived in Wuhan,she denied any bad living hobbies,genetic diseases as well as infectious diseases.Somatoscopy:temperalure(T)37 , bloodpressure(BP) 120/80mmHg, pulse(P)80b/min, respiratory (R) 18/min. The patient had standard development, consciouness entropia and average state of nutrition. She walked into the ward. There was no echimosis or petechia in her skin,and no swellingness of superficial lymph node. She had a standard development of head and five sense organs,no sclera xanthochromia,no lip cyanosis.The neck was soft,the trachea was in the middle side,the thyroid was not swelling.The distension of jugular and thorax deformation was nol seen.The respiratory sound of lung was resonance,no dry gale or met gale was heard.Abadomen was soft and smooth,mass was not palpated.There was no tendness or rebound tenderness.Liver and spleen were not reached under costal arch.Tumefaction were normal,physical reflaction existed and there was no pathological reflextion.Being afraid of the rupture of the ectopic adnexa,bimannal examination was avoided.Process of treatmentthe sufferer's characteristics:(1)Normal blood count,platelets and liver enzymes. (2) Hemodynamic stability. (3) Altough Serum hCG level was above 2000mIU/ml,the patient insisted on conservativetreatment. (4)Ultrasound diameter<3cm medical conservative treatment was administered.The patient received a single-dose of intramuscular methotrexate(MTX) in combination with oral mifepristone 25mg Bid.The serum hCG level on day 4 and day 7 was 2747.4mIU/ml and 2392.3mIU/ml respectively. Because serum hCG levels droped less than 15%, on day 7,50mg MTX was given intramuscularly.then hCG levels was followed on day 11 and day 14. It dropped quickly to 1576mIU/ml and 894mIU/ml on day 22 and 14 respectively.During the whole process, no stomatitis,nausea or vomiting,alopecia or abnormal blood count,elevated liver enzymes were found.The patient were followed up until serum hCG turned negtive in day 35 and menstruation came back on day 49.Chinese traditional medicine was gived to help the adnexal mass to be absorbed quickly.