Obaid Mariam, Abdelazim Ibrahim A, Abu-Faza Mohannad, Rajendran Sobha, Elhaddad Shereen A
Team leader and head of the Obstetrics and Gynecology Department, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait.
Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait.
Prz Menopauzalny. 2022 Jun;21(2):138-141. doi: 10.5114/pm.2022.116433. Epub 2022 May 26.
The incidence of ectopic pregnancy (EP) is about 1.3-2.4%. Approximately 6% of maternal deaths in the first trimester occur following ruptured EP. A 35-year-old lady, G4, P3, pregnant 7 weeks + 2 days, presented with left iliac pain, after positive pregnancy test, and β-human chorionic gonadotropin (β-hCG) 3614 mIU/ml. The transvaginal sonography showed an empty uterus, with a well-defined left adnexal echogenic structure measuring 38×32 mm (left adnexal gestational sac - GS) with foetal pole (bagel sign). The colour Doppler examination showed foetal cardiac activity with circumferential Doppler flow around the GS (ring of fire). She was diagnosed as left undisturbed tubal pregnancy with foetal cardiac activity. She refused the option of laparoscopic surgery. Therefore, she was counselled for medical treatment using methotrexate (MTX). She was also informed that the MTX treatment may fail due to the presence of foetal cardiac activity, and she may need more than one MTX dose. She received the first MTX dose at an initial β-hCG 3614 mIU/ml. The fourth day β-hCG after the first MTX dose was 5421 mIU/ml, while the seventh day β-hCG was 5055 mIU/ml [< 15% decrease of β-hCG (6.75%)]; therefore, she was given a second MTX dose. The fourth day β-hCG after the second MTX dose was 3851 mIU/ml, while the seventh day β-hCG was 2218 mIU/ml [> 15% decrease of β-hCG (42.4%)]; therefore, she was discharged home for follow-up in the outpatient department. This report represents the treatment of left undisturbed tubal pregnancy with foetal cardiac activity using a two-dose MTX regimen.
异位妊娠（EP）的发生率约为1.3 - 2.4%。孕早期约6%的孕产妇死亡是由EP破裂所致。一名35岁女性，孕4产3，孕7周 + 2天，妊娠试验阳性，β-人绒毛膜促性腺激素（β-hCG）为3614 mIU/ml，因左髂部疼痛就诊。经阴道超声检查显示子宫内无妊娠囊，左侧附件区有一界限清晰的强回声结构，大小为38×32 mm（左侧附件区妊娠囊 - GS），可见胎芽（百吉饼征）。彩色多普勒检查显示有胎心活动，妊娠囊周围有环形多普勒血流（火环征）。她被诊断为左侧未破裂输卵管妊娠伴胎心活动。她拒绝了腹腔镜手术治疗。因此，对她进行了使用甲氨蝶呤（MTX）的药物治疗咨询。她也被告知由于存在胎心活动，MTX治疗可能失败，且可能需要不止一剂MTX。她在初始β-hCG为3614 mIU/ml时接受了第一剂MTX。第一剂MTX后的第4天β-hCG为5421 mIU/ml，第7天β-hCG为5055 mIU/ml[β-hCG下降< 15%（6.75%）]；因此，她接受了第二剂MTX。第二剂MTX后的第4天β-hCG为3851 mIU/ml，第7天β-hCG为2218 mIU/ml[β-hCG下降> 15%（42.4%）]；因此，她出院回家，在门诊进行随访。本报告介绍了使用两剂MTX方案治疗左侧未破裂输卵管妊娠伴胎心活动的情况。
