Dhar Hansa, Hamdi Ilham, Rathi Bhawna
Department of Obstetrics and Gynecology, Nizwa Hospital, Nizwa, Oman.
Oman Med J. 2011 Mar;26(2):94-8. doi: 10.5001/omj.2011.24.
Ectopic pregnancy occurs when the embryo fails to implant within the uterine cavity. Methotrexate, a folic acid antagonist has been widely used to treat ectopic pregnancy. The aim of this study is to determine the efficacy of methotrexate treatment for ectopic pregnancies in our settings which will in-turn help us reduce maternal mortality and morbidity.
This was a retrospective review of 60 cases of ectopic pregnancy treated with single dose methotrexate in Nizwa hospital, Oman. Demographic data, clinical presentation, treatment progress, outcome, side effects and future fertility follow up were analysed using a computer database. Selection criteria included hemodynamically stable women with ß-hcg level of ≤5000 mIU/ml, adnexal mass ≤4 cm, absent cardiac activity and hemoperitoneum less than 100 ml. Human chorionic gonadotrophin (hcg) assay and clinical presentation were used to determine cases which warranted surgical intervention.
The success rate of single dose methotrexate therapy in our study was 65% (n=39) and 35% (n=21) required surgical intervention compared to reported success rate of 67-100% published in various studies. Careful selection of cases and confining strictly to the criteria improved the success rate from 40% to 60% in five and half years of the study. The mean average time of resolution of ectopic pregnancy was 32 days for a single dose and 58 days for repeat second or third doses. Eight cases of pregnancy of unknown location were treated successfully with Methotrexate. No major side effects were noted. A successful fertility outcome of 30% in the first year followed by 13.3% in the subsequent second year with a secondary infertility rate of 11.6% was observed in this study.
Methotrexate treatment of ectopic pregnancies is safe and effective with no major side effects. Intramuscular methotrexate has the advantage of tubal conservation and saves patients from requiring surgery. It is easier to administer than intraoperative route, which is by laparoscopy and needs expertise. Our study showed single dose methotrexate to be an effective treatment option for selected patients with unruptured tubal ectopic pregnancy.
当胚胎未能在子宫腔内着床时，就会发生异位妊娠。甲氨蝶呤，一种叶酸拮抗剂，已被广泛用于治疗异位妊娠。本研究的目的是确定在我们的医疗环境中甲氨蝶呤治疗异位妊娠的疗效，这反过来将有助于我们降低孕产妇死亡率和发病率。
这是一项对阿曼尼兹瓦医院60例接受单剂量甲氨蝶呤治疗的异位妊娠病例的回顾性研究。使用计算机数据库分析人口统计学数据、临床表现、治疗进展、结果、副作用以及未来生育情况随访。入选标准包括血流动力学稳定、β - hCG水平≤5000 mIU/ml、附件包块≤4 cm、无心管活动且腹腔内积血少于100 ml的女性。使用人绒毛膜促性腺激素（hcg）检测和临床表现来确定需要手术干预的病例。
在我们的研究中，单剂量甲氨蝶呤治疗的成功率为65%（n = 39），35%（n = 21）需要手术干预，而各项研究报道的成功率为67% - 100%。在研究的五年半时间里，通过仔细选择病例并严格遵循标准，成功率从40%提高到了60%。异位妊娠消退的平均时间，单剂量为32天，重复第二或第三剂量为58天。8例不明部位妊娠病例用甲氨蝶呤成功治疗。未观察到重大副作用。本研究观察到，第一年成功生育的比例为30%，随后第二年为13.3%，继发不孕率为11.6%。
甲氨蝶呤治疗异位妊娠安全有效，无重大副作用。肌内注射甲氨蝶呤具有保留输卵管的优势，使患者无需进行手术。它比术中途径（即腹腔镜手术，需要专业技术）更容易给药。我们的研究表明，单剂量甲氨蝶呤是治疗部分未破裂输卵管异位妊娠患者的有效选择。
