Ntiyakunze Gregory, Gidion Daudi, Kyejo Willbroad, Moshi Brenda, Jaiswal Shweta, Moshi Lynn, Muzo Jane, Chuwa Harrison, Abeid Muzdalifat
Department of Obstetrics and Gynecology, The Aga Khan University, Dar Es Salaam, Tanzania.
Department of Family Medicine, The Aga Khan University, Dar Es Salaam, Tanzania.
SAGE Open Med Case Rep. 2024 May 20;12:2050313X241252348. doi: 10.1177/2050313X241252348. eCollection 2024.
Ectopic pregnancy is a pregnancy in which the developing blastocyst implants outside the endometrial cavity. An estimated 1.3%-2.4% of pregnancies end up outside the uterus. With prompt diagnosis and efficient treatment, the risks of morbidity and mortality associated with ectopic pregnancy can be reduced. For the treatment of carefully chosen ectopic pregnancies, methotrexate therapy, a folic acid antagonist that is highly toxic to rapidly replicating tissues, produces outcomes comparable to surgery. We describe six cases of ectopic pregnancy which were successfully treated with methotrexate and on follow-up two of them successfully conceived to term delivery. For patients who are physically fit enough, medical management of an ectopic pregnancy with methotrexate should be the first line of treatment to lower surgical morbidity and mortality. Following the administration of the medication, the patient is monitored with a clinical symptom interview and weekly plasma human chorionic gonadotrophin levels checks. When initial human chorionic gonadotrophin levels are extremely high, complete resolution of an ectopic pregnancy can take 6-8 weeks instead of the usual 2-3 weeks. Early diagnosis of ectopic pregnancies is necessary to improve their prognosis. Ectopic pregnancies can be managed medically with methotrexate to preserve fertility. Compared to surgical management, methotrexate therapy appears to have more advantages.
异位妊娠是指发育中的胚泡在子宫内膜腔外着床的妊娠。估计有1.3%-2.4%的妊娠最终发生在子宫外。通过及时诊断和有效治疗，可以降低与异位妊娠相关的发病和死亡风险。对于精心挑选的异位妊娠病例，甲氨蝶呤治疗（一种对快速复制组织具有高毒性的叶酸拮抗剂）产生的治疗效果与手术相当。我们描述了6例成功接受甲氨蝶呤治疗的异位妊娠病例，随访发现其中2例成功足月分娩。对于身体状况足够好的患者，用甲氨蝶呤进行异位妊娠的药物治疗应作为降低手术发病率和死亡率的一线治疗方法。给药后，通过临床症状问诊和每周检测血浆人绒毛膜促性腺激素水平对患者进行监测。当初始人绒毛膜促性腺激素水平极高时，异位妊娠的完全消退可能需要6-8周，而不是通常的2-3周。早期诊断异位妊娠对于改善其预后很有必要。异位妊娠可以用甲氨蝶呤进行药物治疗以保留生育能力。与手术治疗相比，甲氨蝶呤治疗似乎具有更多优势。
