Halperin Reuvit, Vaknin Zvika, Schneider David, Yaron Michal, Herman Arie
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin (Affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv), Israel.
Gynecol Obstet Invest. 2003;56(3):148-51. doi: 10.1159/000073774. Epub 2003 Sep 29.
To evaluate the efficacy of conservative management of ectopic pregnancy with fetal cardiac activity by combined local sonographically guided and systemic injection of methotrexate.
The study group included 12 patients with ectopic pregnancy and fetal cardiac activity, treated by combined local and systemic injection of methotrexate in the period from January 1, 2000 to July 1, 2002. The outcome of these patients was compared with the outcome of 53 patients who had ectopic pregnancy without fetal cardiac activity and were being treated only by systemic injection of methotrexate during the same period of time.
The success rate was 91.6% (11 out of 12) in the group of patients with ectopic fetal cardiac activity and 90.5% (48 out of 53) in the group of patients with ectopic pregnancy, but without fetal cardiac activity. There was also no significant difference between the two groups comparing the percentage of cases treated by an additional dose of methotrexate (8.3 and 13.2%, respectively), nor comparing the number of days to resolution of beta-human chorionic gonadotrophin (BHCG; 40 +/- 2 and 34 +/- 10 days, respectively). Conversely, there was a significant difference in the initial BHCG level comparing the group of patients treated by combined local and systemic injection of methotrexate (12,616 +/- 9,585 mIU/ml) and the group of patients treated by systemic injection of methotrexate (1,499 +/- 2,065 mIU/ml) (p < 0.00001). Seventy-five percent of patients (6 out of 8) diagnosed with ectopic fetal cardiac activity, who desired to become pregnant, succeeded to conceive within 6 months following the combined local and systemic injection of methotrexate.
The combined local sonographically guided and systemic injection of methotrexate is associated with a successful outcome in asymptomatic patients presenting with ectopic pregnancy and fetal cardiac activity.
评估局部超声引导联合全身注射甲氨蝶呤保守治疗有胎心搏动的异位妊娠的疗效。
研究组包括12例有胎心搏动的异位妊娠患者，于2000年1月1日至2002年7月1日期间接受局部和全身联合注射甲氨蝶呤治疗。将这些患者的治疗结果与同期53例无胎心搏动的异位妊娠患者仅接受全身注射甲氨蝶呤的治疗结果进行比较。
有异位胎心搏动的患者组成功率为91.6%（12例中的11例），异位妊娠但无胎心搏动的患者组成功率为90.5%（53例中的48例）。两组在额外注射一剂甲氨蝶呤的病例百分比（分别为8.3%和13.2%）以及β-人绒毛膜促性腺激素（BHCG）降至正常的天数（分别为40±2天和34±10天）方面也无显著差异。相反，局部和全身联合注射甲氨蝶呤治疗的患者组与仅接受全身注射甲氨蝶呤治疗的患者组相比，初始BHCG水平存在显著差异（分别为12,616±9,585 mIU/ml和1,499±2,065 mIU/ml）（p<0.00001）。8例希望怀孕且被诊断为有异位胎心搏动的患者中，75%（6例）在局部和全身联合注射甲氨蝶呤后的6个月内成功受孕。
局部超声引导联合全身注射甲氨蝶呤治疗无症状的有胎心搏动的异位妊娠患者，疗效良好。
