Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
Biomed Res Int. 2020 Aug 1;2020:8703496. doi: 10.1155/2020/8703496. eCollection 2020.
Interstitial pregnancy (IP) is an ectopic pregnancy (EP) located in the portion of the fallopian tube that penetrates the uterine muscular layer. Incidence increased in the last two decades with the widespread use of the assisted reproductive techniques. It is estimated in 1-6% of all the EPs, with a maternal mortality rate of 2.0-2.5%. Clinical presentation, gestational age at diagnosis, beta-human chorionic gonadotropin (-hCG) levels, ultrasound features, and patient preference, should be considered to determine the best management: surgical, medical treatment, or close observation. We report two cases of IP successfully managed with systemic MTX and Mifepristone: in one case -hCG was >10.000 mIU/mL and a vital embryo was present.
A literature search was carried out on MEDLINE, EMBASE, and PUBMED. We identified two cases of IP referred to the Institute for Maternal and Child Burlo Garofolo, Trieste. Data related to clinical presentation, -hCG, and ultrasound scan at the moment of the diagnosis were recorded. In one of the cases, the -hCG level was >10.000 mIU/mL, and a vital embryo was testified at an ultrasound scan. The patient was asymptomatic and she was treated using multidose systemic Methotrexate (MTX) combined with Mifepristone. In the second case, in the presence of a clinically stable patient with - hCG > 10.000 mIU/mL, it was chosen that the administration of Mifepristone combined with a double dose of MTX. -hCG levels and ultrasound examinations were performed weekly until a complete resolution of the IP.
In the first case, -hCG dropped down in 5 days and became undetachable in 30 days. In the second case, -hCG became undetectable in 47 days. The first-line therapy in asymptomatic women could be addressed to a combined protocol, consisting of a systemic multidose MTX regimen with a single oral dose of Mifepristone.
Clinical management of IP remains a debated topic. In selected cases, a systemic multidose MTX regimen combined with a single oral dose of Mifepristone could be considered also in the presence of high serum -hCG.
间质部妊娠（IP）是一种位于输卵管穿透子宫肌层部分的异位妊娠（EP）。随着辅助生殖技术的广泛应用，过去二十年来，其发病率有所增加。它估计占所有 EP 的 1-6%，其孕产妇死亡率为 2.0-2.5%。应考虑临床表现、诊断时的孕龄、β-人绒毛膜促性腺激素（-hCG）水平、超声特征和患者偏好，以确定最佳治疗方法：手术、药物治疗或密切观察。我们报告了两例成功使用全身性甲氨蝶呤（MTX）和米非司酮治疗的 IP 病例：在一例中，-hCG>10000 mIU/mL，且存在有活力的胚胎。
在 MEDLINE、EMBASE 和 PUBMED 上进行了文献检索。我们确定了转诊至的里雅斯特 Burlo Garofolo 母婴研究所的两例 IP 病例。记录了与临床表现、-hCG 和诊断时的超声扫描相关的数据。在一例中，-hCG 水平>10000 mIU/mL，超声扫描证实存在有活力的胚胎。患者无症状，接受了多剂量全身性甲氨蝶呤（MTX）联合米非司酮治疗。在第二例中，在存在临床稳定且-hCG>10000 mIU/mL 的患者中，选择给予米非司酮联合双倍剂量 MTX。每周进行 -hCG 水平和超声检查，直到 IP 完全消退。
在第一例中，-hCG 在 5 天内下降，在 30 天内无法检测到。在第二例中，-hCG 在 47 天内无法检测到。无症状妇女的一线治疗方法可以采用联合方案，包括全身性多剂量 MTX 方案和单次口服米非司酮。
IP 的临床管理仍然是一个有争议的话题。在选择的病例中，即使血清 -hCG 水平较高，也可以考虑全身性多剂量 MTX 方案联合单次口服米非司酮。
