Tanaka Keisuke, Baartz David, Khoo Soot Keat
Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2015 Apr;55(2):176-80. doi: 10.1111/ajo.12315. Epub 2015 Apr 14.
Interstitial ectopic pregnancy is a rare but potentially life threatening condition. Of the three management options for this condition (expectant, medical and surgical treatment) methotrexate therapy in several regimens has been reported to be effective and beneficial.
To assess the safety and efficacy of intravenous bolus and infusion of methotrexate with folinic acid rescue for the treatment of interstitial ectopic pregnancy.
A retrospective cohort study of women with interstitial ectopic pregnancy treated with methotrexate at the Royal Brisbane and Women's Hospital from April 2000 to December 2012. The treatment regimen comprised of a bolus dose of methotrexate 100 mg followed by 200 mg of methotrexate infusion over 12 h. Four doses of 15 mg oral folinic acid rescue were given post-treatment. Success of methotrexate therapy was confirmed by either a negative serum beta-human chorionic gonadotropin (β-hCG) level or subsequent uneventful pregnancy.
Of 33 women with interstitial ectopic pregnancy who were treated with this regimen, 31 (93.9%) were treated successfully, including women with a high β-hCG level up to 106 634 IU/L and the presence of fetal cardiac activity. Minor side effects were documented in three cases.
Intravenous methotrexate therapy with folinic acid rescue is well tolerated and highly effective.
间质部异位妊娠是一种罕见但可能危及生命的情况。对于这种情况的三种治疗选择（期待治疗、药物治疗和手术治疗），据报道，几种方案的甲氨蝶呤治疗是有效且有益的。
评估静脉推注和输注甲氨蝶呤并联合亚叶酸解救治疗间质部异位妊娠的安全性和有效性。
对2000年4月至2012年12月在皇家布里斯班妇女医院接受甲氨蝶呤治疗的间质部异位妊娠妇女进行回顾性队列研究。治疗方案包括静脉推注100mg甲氨蝶呤，随后在12小时内输注200mg甲氨蝶呤。治疗后给予四剂15mg口服亚叶酸解救。甲氨蝶呤治疗成功通过血清β-人绒毛膜促性腺激素（β-hCG）水平阴性或随后的正常妊娠来确认。
采用该方案治疗的33例间质部异位妊娠妇女中，31例（93.9%）治疗成功，包括β-hCG水平高达106634IU/L且有胎心活动的妇女。3例记录有轻微副作用。
静脉注射甲氨蝶呤联合亚叶酸解救治疗耐受性良好且高效。
