Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore.
Singapore Med J. 2009 Nov;50(11):1058-61.
Ectopic pregnancy is an acute emergency in the first trimester where surgery is the mainstay of treatment. With the advent of improved diagnostic techniques like high-resolution transvaginal ultrasonography and expedient serum human chorionic gonadotrophin (HCG) assay, ectopic pregnancy is now diagnosed early. At this stage, the conceptus is often small, causing minimal or no symptoms. Medical management may then present an appealing alternative to surgery. Methotrexate has been widely used to treat ectopic pregnancy. A methotrexate ectopic treatment protocol was introduced by the Minimally Invasive Surgery Centre at KK Women's and Children's Hospital, Singapore. We present the results of this treatment.
A prospective review of 110 cases of medical management of ectopic pregnancy since the implementation of the treatment protocol was undertaken. Demographical data, clinical presentation, treatment progress and outcome were captured using a computer database. All patients were managed as outpatients, and a telephone call-out service was provided to ensure that treatment side effects were monitored and potential treatment failures were identified early.
From August 2003 to October 2006, 93 (84.5 percent) patients with ectopic pregnancy were successfully treated with intramuscular methotrexate. 16 patients eventually required surgery and only one patient defaulted on follow-up. There was no major side effect detected in this cohort. The minor side effects reported included mucositis (19.1 percent) and abdominal pain (28.2 percent).
Methotrexate treatment of ectopic pregnancy is safe. Our treatment protocol enabled us to achieve a reasonable treatment success rate of 84.5 percent.
异位妊娠是妊娠早期的一种急性急症，手术是主要的治疗方法。随着高分辨率经阴道超声和快速血清人绒毛膜促性腺激素（hCG）检测等诊断技术的进步，异位妊娠现在可以早期诊断。在这个阶段，胚胎通常很小，导致症状轻微或没有症状。因此，药物治疗可能是手术的替代选择。甲氨蝶呤已被广泛用于治疗异位妊娠。新加坡 KK 妇女儿童医院微创外科中心引入了一种甲氨蝶呤异位妊娠治疗方案。我们介绍了这种治疗方法的结果。
对自该治疗方案实施以来的 110 例异位妊娠药物治疗进行了前瞻性回顾。使用计算机数据库记录人口统计学数据、临床表现、治疗进展和结果。所有患者均作为门诊患者进行管理，并提供电话呼叫服务，以确保监测治疗副作用，并尽早发现潜在的治疗失败。
2003 年 8 月至 2006 年 10 月，93 例（84.5%）异位妊娠患者成功接受肌内注射甲氨蝶呤治疗。16 例患者最终需要手术，只有 1 例患者失访。该队列中未发现主要副作用。报告的轻微副作用包括粘膜炎（19.1%）和腹痛（28.2%）。
甲氨蝶呤治疗异位妊娠是安全的。我们的治疗方案使我们能够实现 84.5%的合理治疗成功率。
