Fridman Dmitry, Hawkins Eleanor, Dar Peer, Chudnoff Scott, Rotenberg Ohad, Chong Woojin, Xie Xianhong, Mehta Sukrant, Levie Mark
Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, Bronx, New York, USA.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
J Ultrasound Med. 2019 Mar;38(3):675-684. doi: 10.1002/jum.14751. Epub 2018 Sep 23.
To report clinical experience with methotrexate (MTX) treatment for suspected but not definite ectopic pregnancy (EP).
This was a retrospective cohort study. All patients treated with MTX for presumed EP between 2000 and 2016 were included. Demographic, clinical, sonographic, and outcome data were collected and analyzed.
A total of 820 patients were treated with MTX, 692 (84.4%) of which were lacking definitive features of EP; 155 (22.4%) failed to follow up until complete resolution and were excluded. Retrospective sonographic categorization was applied to 537 patients; of those patients, 393 (73.2%) were categorized as probable EPs, 136 (25.3%) pregnancies of unknown location (PULs), and 8 (1.5%) probable intrauterine pregnancies (IUPs). Sixteen were eventually diagnosed with IUP: 6 from the probable EPs, 9 from the PULs, and 1 from the probable IUP group. Patients with final diagnosis of IUP had higher values of β-human chorionic gonadotropin as well as lower prevalence of adnexal mass (38% versus 74%; P = .003), higher prevalence of intracavitary fluid (44% versus 9%; P = .0004) and thicker endometrium (17.1 ± 11.8 versus 9.7 ± 5.6; P = .04). None of the sonographic parameters were able to distinguish patients with IUP. One patient of the 16 with IUP was diagnosed with a viable pregnancy, and 7 additional patients had a possible viable pregnancy. None of them elected to continue the pregnancy.
Most patients with suspected EP who are eligible for medical treatment lack definitive sonographic features of EP. Treatment with MTX in such cases should be delayed, as clinically reasonable, to improve the diagnosis and prevent inadvertent administration of MTX to patients with a viable IUP.
报告甲氨蝶呤（MTX）治疗疑似但未确诊异位妊娠（EP）的临床经验。
这是一项回顾性队列研究。纳入2000年至2016年间所有接受MTX治疗疑似EP的患者。收集并分析人口统计学、临床、超声及结局数据。
共有820例患者接受MTX治疗，其中692例（84.4%）缺乏EP的明确特征；155例（22.4%）未随访至完全缓解而被排除。对537例患者进行回顾性超声分类；其中，393例（73.2%）被分类为可能的EP，136例（25.3%）为妊娠位置不明（PUL），8例（1.5%）为可能的宫内妊娠（IUP）。最终16例被诊断为IUP：6例来自可能的EP组，9例来自PUL组，1例来自可能的IUP组。最终诊断为IUP的患者β-人绒毛膜促性腺激素值较高，附件包块发生率较低（38%对74%；P = 0.003），宫腔积液发生率较高（44%对9%；P = 0.0004），子宫内膜较厚（17.1±11.8对9.7±5.6；P = 0.04）。没有超声参数能够区分IUP患者。16例IUP患者中有1例被诊断为活胎妊娠，另外7例可能为活胎妊娠。他们均未选择继续妊娠。
大多数符合药物治疗条件的疑似EP患者缺乏EP的明确超声特征。在这种情况下，应根据临床情况合理延迟MTX治疗，以改善诊断并防止对活胎IUP患者误服MTX。
