Clinical Analysis Of Tubal Rupture Among Ectopic Pregnancy Treated With Methotrex-ate

Objectives: We analyze the risk factors of abruption caused bleeding in oviduct tubalpregnancy during MTX conservative therapy, further providing clinical guidance.Methods:1. Methods and subjects:We retrospectively collected131cases of tubal pregnancy conservative therapy inDalian Medical University First Affiliated Hospital from Jan.2012to Dec.2013.Among these, successful tubal pregnancy conservative therapy112cases, abruptionwith surgical therapy21case. The basic characteristics of tubal pregnancy patientsincludes: age, pregnancy days (pregnancy weeks), bleeding days, time of pregnancy,time of delivery, history of pregnancy, ultrasound, blood HCG, Ph value. We dividedthe131cases into A and B groups: Group A for tubal pregnancy abruption (21cases),group B for successful conservative therapy (110cases) as the control.2. Study materials:1) Statistical analysis of the clinical charateristics in the two groups: age, menopausedays (pregnancy weeks), vaginal bleeding days, time of pregnancy, time of delivery,history ectopic pregnancy.2) Comparative analysis of the three conditions of the blood B-HCG in the two groups:the initial blood B-HCG level pre-meds, the elevation ratio of blood B-HCG>60%48hr. post-meds, and persistent elevation post-meds.3) Analysis of related factors of the tubal abruption bleeding in the conservativetherapy for the two groups.4) Analysis and evaluation of the ultrasound and colored Doppler (mass size, pelvicfluid, blood flow signal) to the abruption bleeding in the ectopic pregnancy.Results：1. There were no significant difference in the basic materials, including age, menopausedays (pregnancy week), days of vaginal bleeding, pregnancy times, delivery times, and history of ectopic pregnancy, between the two clinical groups among the131cases oftubal pregnancy abruption.2. There was no significant difference in the original blood B-HCG (<5000mIU/ml)between the abruption A group and the conservative successful B group (P>0.05). Therewere significant difference in the blood B-HCG pre-med48hr. increasing rate>60%and that of post-med between the abruption A group and the conservative successful Bgroup (P<0.05).3.There was no significant difference of the ectopic pregnancy mass size (diameter atbetween1.1-7.3cm) between the abruption A group and the conservative successful Bgroup.4.There was significant difference in the blood progesterone value abruption A groupand conservation successful B group (P<0.05).5.There were significant difference in the blood flow signals of the accessary masssurrounding detected by the color Doppler between the abruption A and conservative Bgroup (P<0.05).6. There was no significant difference of the pelvic fluid amount detected by theultrasound between the abruption A group and the conservative successful B group.Conclusion:1. Dynamic detecting the rate of HCG elevation pre-and post-med was a goodindicator of tubal abruption bleeding during the ectopic pregnancy MTX conservativetherapy. When the HCG elevation rate was over60%/48hr pre-med or B-HCGpersistent high post-med during the medication conservative treatment, the risk for tubalabruption bleeding was high, considering the operative therapy.2.The value of progesterone was the important reference indicator for evaluation of theoutcome in the medication conservative treatment.3. According to the Doppler colored ultrasound suggested blood flow signal around theaccessary area, the circular blood flow predicts good development of the fetus. Thefailure rate of medication conservative therapy may reach60%.4.Only by the mass size of the accessary and pelvic fluid amount (<4cm), it is hard tojudge the outcome of the MTX conservative therapy.