Sargin Mehmet Akif, Yassa Murat, Taymur Bilge Dogan, Çelik Ayhan, Aydin Sibel, Orhan Emrah, Tug Niyazi
Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey .
Lecturer, Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital , İstanbul, Turkey .
J Clin Diagn Res. 2016 Aug;10(8):QC22-6. doi: 10.7860/JCDR/2016/20363.8376. Epub 2016 Aug 1.
Extra-uterine pregnancy or Ectopic Pregnancy (EP) is a major health problem for pregnant women, presenting as a potentially life-threatening emergency in the first trimester. There are three major options for the treatment of EP: expectant management, surgical treatment and medical management. The presence of free intraperitoneal fluid in EP-diagnosed patients is crucial for treatment planning and evaluation.
To compare the outcomes of both the expectant man-agement and medical treatment with methotrexate (MTX) in ectopic pregnancies with free intraperitoneal fluid.
This retrospective cohort study inclu-ded a total of 91 ectopic pregnancies with or without rupture in which the women had initial free intraperitoneal fluid and were haemodynamically stable. Serial β-HCG measurements were used to assess the outcome of expectant management and medical treatment with MTX. For the statistical analysis, the SPSS statistical software package, version 22.0 (Chicago, IL, USA), was used. For the quantitative variables that were not distributed normally, the Kruskal-Wallis test and the Mann-Whitney U test were performed for the evaluation of differences between the groups.
It was observed that the success rate with expectant management was 81% (initial β HCG concentration 626±443 mIU/mL). With a single dose of MTX, it was 76% (initial β HCG concentration 2124±1647 mIU/mL) and with a total single or double dose of MTX, it was 88% (initial β HCG concentration 2252±78 mIU/mL) from among EP with or without rupture in women with initial free intraperitoneal fluid during diagnosis. There was no significant difference between the groups with regard to ultrasonography findings.
Expectant management or medical treatment with methotrexate should be the first line treatment for ectopic pregnancies with initial free intraperitoneal fluid, albeit with rupture, in patients who are haemodynamically stable, along with β-HCG follow-up.
宫外孕或异位妊娠（EP）是孕妇面临的一个主要健康问题，在孕早期表现为可能危及生命的紧急情况。宫外孕的治疗有三种主要选择：期待治疗、手术治疗和药物治疗。在诊断为宫外孕的患者中，腹腔内游离液体的存在对于治疗方案的制定和评估至关重要。
比较在有腹腔内游离液体的异位妊娠中，期待治疗和甲氨蝶呤（MTX）药物治疗的效果。
这项回顾性队列研究共纳入91例有或无破裂的异位妊娠患者，这些女性最初有腹腔内游离液体且血流动力学稳定。通过连续检测β-HCG来评估期待治疗和MTX药物治疗的效果。统计分析使用SPSS统计软件包22.0版（美国伊利诺伊州芝加哥）。对于非正态分布的定量变量，采用Kruskal-Wallis检验和Mann-Whitney U检验来评估组间差异。
观察到期待治疗的成功率为81%（初始β-HCG浓度为626±443 mIU/mL）。单剂量MTX治疗的成功率为76%（初始β-HCG浓度为2124±1647 mIU/mL），单次或两次总剂量MTX治疗的成功率为88%（初始β-HCG浓度为2252±78 mIU/mL），这些数据来自诊断时最初有腹腔内游离液体的有或无破裂的宫外孕女性患者。在超声检查结果方面，各组之间没有显著差异。
对于诊断时最初有腹腔内游离液体、虽有破裂但血流动力学稳定的宫外孕患者，期待治疗或甲氨蝶呤药物治疗应作为一线治疗方法，并进行β-HCG随访。
