The Comparision Of Three Mathods For Treating Ectopic Pregnancies Conservatively By Medicine

By analyzing the clinical materials of ectopic materials ofectopic pregnancy, discuss the difference between two medicines(methotrexate and mifepristone) and two intaking ways ofmethotrexate in the espects of curative effect and prognosis.We conducted a retrospective review of 90 ectopic pregnancyof the Second Hospital of the Jilin University and the Obstetric andGynecologic Hospital of Changchun City, with medical-conservativemanagement between 2004.3 ～ 2005.10. All the patients wasdevided in to group A ,B,C at random. Record the ages ,pregnanttimes, the time of pause menstruate, the size of the block in pelbiccavity, blood β-hCG .The following character must be needed byevery patient:1. The existence of pause menstruate, and /or vaginalirregularily bleeding ,companied by low abdominal pain. An adnexalmass can be felt in physical examination.2. No intrauterine gestational sac was traced by transvaginalultrasonography , proliferated endomentrium may be presented ,Unilateral complex adnexal masor gestational saclike adnexal ringmay be seen whithout fetal cardiac. The diameter of the mass is lessthan 4cm.3. The serumβ-hCG concentration is more than 1000 mIU/ml,but less than 3000 mIU/ml, or rise less than 66% in 48 hours.4. The function of the live and renal, thromboplastic function ,hemogram, platelet , ALT, Cr must be nomal.5.Unruptured or patial ruptured without unstablehemodynamics and shock sign.6.Voluntarily accept the conservative treatment and have thewilling of regregnancy . Have the every advantage condition back tothe hospital.90 patients were divided into three groups evenly at random.A group: mifepristone 50 mg Bid by oral 3 days in arrow .B group: MTX im deeply every dose is 20mg every twodays, four times (in No.1,3,5,7th day).C group: 50mg MTX im , integrating ogan part injectionthrough oviduct .To judge the function of the tubal, the tubal patency fluid31experiments were conducted during third and seventh days after theceasing of menstrual bleeding .There were not any distinct differencestatistically among the three groups in age,the time of pausemenstrual,the size of the block in pelbic cavity, blood β-hCG(p>0.05).The average cost in patient of the three groups is(1248±160.6 yuan),(1638±302.6 yuan),(1638±302.6 yuan)separarly.The average period of hospitalization is (16.22±2.96day),( 18.84±3.02 day),(12.26±3.11 day)separarly.The averagetime of serum β -hCG restoring to momal level is(14.76±6.88 day),(15.90±7.16 day ),(10.65±5.37 day)separarly。The tubal patencyrate of the three groups is 78.9%, 80% ,78.3%separarly。Thesuccess rate of the three group s is 73.33%,76.67%,83.33%.Thereis no distinct difference among the three groups on the cost andsuccess rate(p>0.05). And no distinct difference between group Aand group B on the hospitalization period and serum β -hCGrestoring time(p>0.05). But GroupC is obviously shorter than theother two groups on the hospitalization period and serum β -hCGrestoring time(p>0.05).This difference is distinct . There is nodistinct difference between groupB and groupC on the side effect ofMTX . There is no distinct difference among the three groups on thethe tubal patency rate (p>0.05). In long term, nomal pregnancy rateand second (or more ) ectopic pregnancy rate are still unclear untilmore study and work has been done and more time has beentaking .The occurrence rate of side effect for groupA is 10%, lowerthan groupA and groupB, and the sumpton is much mild and easy togo. Mifepristone is a kind of effective,safe ,convinient medicine.It's also fit for out-patient. More ectopic pregnancybe dignosedearlier than before , more mifepristone will be used . It is beenreported that the integration MTX and mifepristone will decrease theside effect. For the unrupture patients, these two drugs could obtainmaximal success rate,decrease the treatment period and the sideeffect. And maybe the best and first –concerned way, especially forthe childless woman. There are three ways fo ectopic patients tointake the medicine: ogan local injection,whole body by circulation,organ local injection plus whole body by circulation. The pureorgan local injection is not the point of this study, and maybeprevented in clinical practice. There are three ways mainly for organlocal injection:1. Directly puncture through skin or vagina to injection MTXunder ultrasound.2. Tubal intubatton by hysteroscopy injection MTX3. Tubal injection by laparoscopic injection MTX.Tubal intubatton by hysteroscopy injection MTX is better thanthe orther two ways because of no risk for the anaesthesia and itshurtlessness. It is an easy choice for the patient during the crises,especially welcome to the patients who have suffered anyabdomen surgical before and are unwilling to take an other one.Bythis way ,the childless woman could save his tubal function. Ofcourse the doctor's skillful operation is very crucial for the successrate .Basing on the upper dicuss the following conclusion maybemade :1.MTX and mifepristone are two kinds of effective medicinefor ectopic pregnancy conservative management by medicine. Inclinical practice they play an equal role for the curative effect.TheMTX is widely used and deeply studied on many details ,such asdoses and injection ways. Mifepristone is convenient for use andhave a small range side effect ,fited for out-patient and patient whosuffered from renal or liver disfunction.Their pharmacologicalmechanism is different and the two medicine may offset each other'sweakness, so the integration of MTX and mifepristone is highlyrecommended.2. Although the tubal intubatton by hysteroscopy injectionMTX is fail to make a higher curative effect, it still may make abreakthrough contribution for some special ectopic pregnance ,anddecreases the treatment period .3. The tubal intubatton by hysteroscopy injection MTX is abest way for ectopic pregnancy conservative management bymedicine.The advantage is unplacable by the other two ways.4. The integration of organ local and whole body bycirculation is a highly recommended way for MTX injection, pureorgan local way is at least prevented.5. Both the variety choice between the two medicine and theways fot intaking can not change the fecundity after theconservative treantment .