Lin ChiaJu, Hsieh HsiaoYun
Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, TWN.
Cureus. 2021 Nov 18;13(11):e19686. doi: 10.7759/cureus.19686. eCollection 2021 Nov.
Methotrexate (MTX) is known as a systemic treatment for early ectopic pregnancy with low serum beta-human chorionic gonadotropin (βhCG) levels. Here we present our experience of an unsatisfactory outcome following MTX treatment for early tubal pregnancy. The case is a 39-year-old female with left tubal ectopic pregnancy and a history of one right tubal ectopic pregnancy and an uneventful episode of delivery. In the absence of any contraindications, the patient underwent initial MTX treatment. At first, her serum βhCG level was 1,258 mIU/mL but remained elevated. Then she underwent a second and third dose of MTX. After a month, the serum βhCG level had not declined to within an acceptable range. The ectopic mass was enlarged as determined by transvaginal ultrasonography and hemoperitoneum. A laparoscopic salpingectomy was performed. Early ectopic tubal pregnancy can be managed medically with a high success rate. However, repeat ectopic pregnancy indicates an increased risk of treatment failure to medical treatment, and should be mentioned to the patient when discussing their treatment options.
甲氨蝶呤（MTX）是一种用于血清β-人绒毛膜促性腺激素（βhCG）水平较低的早期异位妊娠的全身治疗方法。在此，我们介绍了甲氨蝶呤治疗早期输卵管妊娠后结果不理想的经验。该病例为一名39岁女性，左侧输卵管异位妊娠，既往有一次右侧输卵管异位妊娠史，顺产一次。在无任何禁忌证的情况下，患者接受了初始甲氨蝶呤治疗。起初，她的血清βhCG水平为1258 mIU/mL，但仍持续升高。随后她接受了第二剂和第三剂甲氨蝶呤治疗。一个月后，血清βhCG水平未降至可接受范围内。经阴道超声检查确定异位包块增大且有腹腔内出血。遂行腹腔镜输卵管切除术。早期输卵管异位妊娠可通过药物治疗获得较高成功率。然而，重复性异位妊娠表明药物治疗失败的风险增加，在与患者讨论治疗方案时应告知患者这一点。
