Methotrexate Treatment of Ectopic Pregnancy: Prognosis at Senlis Hospital

Introduction: Ectopic pregnancy is dreadful and can lead to the death of the patient if it is ignored. Diagnosed early, it offers the possibility of medical treatment with methotrexate. Objective: To describe the prognosis of ectopic pregnancies treated methotrexate. Patients and Methods: Retrospective study of the management of ectopic pregnancy by Methotrexate at Senlis hospital from June 2020 to May 2021 were included in the study, patients with a Fernandez score of less than 13, and having received Methotrexate as first-line treatment. Data were collected using gynecological emergency admission registers, and telephone interviews. Results: 35 cases were identified. The average age of the patients was 32 years old. Forty-nine percent were smokers. The mean gestational age was 5 weeks + 2 days. The diagnosis was made in all of our patients with the combination of the kinetics of ß-hcg and vaginal ultrasound. The size of adnexal mass was less than 4 cm with an average size of 20 mm. The average value of ß-hcg was 1405 IU/L. All patients had received a single dose of methotrexate 1 mg/kg intramuscularly. A second dose was administered to 17.1% of patients for stagnation or re-ascension of the ß-hcg level. The success rate was 91.4%. Thirty percent were obtained spontaneous intra uterine pregnancy, the first year following methotrexate treatment. Conclusion: The success rate of medical treatment for ectopic pregnancy is high in terms of meeting the eligibility criteria for treatment. The subsequent prognosis of fertility is generally preserved.

Interstitial Ectopic Pregnancy Treated with Multi-Dose Methotrexate Protocol

Interstitial ectopic pregnancies are very rare, however, they are extremely dangerous. Treatment consists of either surgical or medical management. This patient presented with no prior pregnancies, an inappropriately rising b-hCG, and eventually had ultrasound findings consistent with interstitial ectopic pregnancy. She was seen through the Emergency Department and had no insurance. She strongly desired to avoid surgery, and was successfully given a multi-dose regimen of methotrexate. Contraindication to methotrexate management includes an inability to follow-up, so a close therapeutic alliance was maintained to enable safe resolution of this case. She has since successfully carried an uncomplicated intrauterine pregnancy to term.

Conservative Management of Unruptured Ectopic Pregnancy—A Retrospective Study

An ectopic pregnancy (EP) is defined as any pregnancy that occurs outside the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. The goal of this retrospective study is to address medical and conservative surgical management of unruptured fallopian tube EP as an effective manner to preserve tubes to prevent secondary infertility. This study was conducted between January 1, 2010, and April 30, 2024, in Ponni Hospital, Madurai. It included 319 women, out of 6248 pregnant women diagnosed with ectopic pregnancy by using an Inexecreen kit, trans-abdominal scan, trans-vaginal scan, and doubling of beta-human chorionic gonadotropin (β-HCG) in 48 hours and Magnetic Resonance Imaging (MRI). Medical and conservative surgical management were given to those patients effectively. Out of 319 patients, 62 patients (19.4%) had a ruptured ectopic pregnancy and underwent surgical treatment;257 patients (80.6%) had an unruptured ectopic pregnancy. The conservative medical management was provided to 257 patients. Out of 257 patients, 235 patients were treated by injecting methotrexate and folic acid rescue when the criteria were met. 14 patients had salpingostomy and injection methotrexate (Inj. Methotrexate) and inj. Prostaglandin F2 alpha was administered into the tubal wall to preserve tubes. 8 patients had a live ectopic pregnancy;for those patients, Inj. Methotrexate was injected into the gestational sac through ultrasound guidance. 225 out of 257 patients reached out to us to seek fertility treatment;the remaining 32 patients were not seeking fertility. All fertility-seeking patients had successful pregnancies. We lost follow-up of 12 patients in this study. Out of 213 patients who came for fertility treatment, a 76.1% success rate was achieved with live birth, the recurrent ectopic pregnancy rate was 13.6%, the miscarriage and stillbirth rates were 10.3%. 32 patients, who were not seeking fertility, had quality life without surgical scars for ectopic pregnancy and cost-effective treatment. 25 patients out of 32 had laparoscopic sterilization later, and 7 patients followed temporary contraception as per our advice. This clinical data was retrieved from medical records.

Conservative treatment of unruptured Ectopic pregnancy in Jamaica

Medical treatment with methotrexate is now successfully replacing conservative surgical treatment in selected patients. We reviewed patients treated with methotrexate, compared to salpingectomy and salpingostomy between 1990 to 1995 and 2000 to 2003. For 1990-1995 there were 21 conservative surgical treatments (5.3% ectopic pregnancies). The ratio of ectopic to normal deliveries was 1:24. Medical treatment was done for 19 pregnancies (3.4% of ectopic pregnancies) for 2000 to 2003. During the period there was an ectopic rate of 1:16.8 births. Patients treated medically were similar to those treated surgically except that none reportedly having rebound tenderness and only 1/18 having an ultrasound scan showing a foetal heart and none with a gestational sac >4cm. In the medically treated group the success rate was 68% while in the surgically treated groups success was 100%. There was no significant difference in the parameters in the conservative surgical and medically treated

Avoiding misdiagnosing an early intrauterine pregnancy as an ectopic pregnancy

In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment for ectopic pregnancy. The diagnosis of ectopic pregnancy, unless directly visualized with transvaginal ultrasound, is made with the exclusion of an intrauterine pregnancy. Measurement of human chorionic gonadotrophin and progesterone levels, and transvaginal ultrasound are the tools used to evaluate early pregnancy. In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment course. Methotrexate is an antimetabolite that inhibits DNA synthesis and repair and cell replication. It is administered to ostensible destroy a pregnancy, especially ectopic pregnancies. When administered to an intrauterine pregnancy, embryonic death and missed abortion is the most common result, but early embryos that survive this exposure are likely to have multiple anomalies. The mistaken administration of methotrexate to an intrauterine pregnancy is made because of misinterpretation of the discriminatory zone of human chorionic gonadotropin(h CG), misinterpretation of early h CG serum levels, misinterpretation of early transvaginal ultrasound images, and failure to clinically correlate h CG levels and ultrasound findings.

Viable Second Trimester Cervical Ectopic Pregnancy Managed Successfully with Uterine Preservation: Case Report

Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5% of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were misleading. Several weeks later, a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.

Single-Dose Methotrexate Combined with Chinese Medicinal Herbs Treated Unruptured and Ruptured Ectopic Pregnancy

Objective: To explore the therapeutic effect of single-dose methotrexate (MTX) with Chinesemedicinal herbs in the treatment of ectopic pregnancy(EP). Methods: Eighty-five patients with unruptured andruptured EP were prospectively treated with an intramuscular injection of MTX (50 mg/m') without citrovorumfactor rescue to destroy embryo and villi, meanwhile, EP 1 decoction was given orally, in the case of rupturedEP with active internal hemorrhage resulted from EP mass rupture, or EP 2 decoction was given orally, In thecase of unruptured EP and ruptured EP without active internal hemorrhage resulted from EP mass rhexis andblood in the peritoneal cavity has already formed hematomas. The serum human chorionic gonadotropin (hCG)3-subunit were monitored regularly until they were undetectable. Serial B-ultrasound examinations were followedup by observing the gestational sac, fetal cardiac activity, EP mass absorption, etc. Of those who has the desireof being pregnant, after all EP mass disappeared, hysterosalpingogram may be performed. Results: The total of81 cases (95. 3 % ) were successfully treated without surgical operation, 4 cases (4. 7 % ) required surgical management of EP. The mean serum hCG 5-subunit clearance time was 18. 7 i 7. 2 days. Total disappearance of EPmass assessed by transvaginal ultrasonography, was 1. 2 1 0. 7 months. Hysterosalpingograms done on 20 patients of attempting pregnancy subsequently demonstrated tubal patency in 90. 0 % .(18 cases) on the affectedside. To date, 15 intrauterine pregnancies have occurred in this group, none of the patients were recurrent EP.Conclusions: EP were treated with integrated traditional Chinese and western medicine, it may expand the EPindication treated with MTX alone, elevate cure rate and obtain ideal efficacy without surgical intervention.

Mifepristone in treating ectopic pregnancy

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Clinical Study of Ectopic Pregnancy Treated with Integrated Traditional Chinese and Western Medicine

Objective: To explore the therapeutic effect and mechanism of integrated traditional Chinese and western medicine (TCM-WM) in treating ectopic pregnancy (EP). Methods: Seventy-eight patients suffering from unruptured EP were divided into two groups at random in proportion of roughly 2∶1, Group Ⅰ(n=50) was treated with methotrexate (MTX) plus Ectopic Pregnancy No.2 (EP2), a Chinese medicinal decoction, Group Ⅱ (n=28) was treated with MTX alone for control. Results:In Group Ⅰ, the nonsurgical cure rate, involving side tubal patency rate and intrauterine pregnancy rate, were 98.0%, 88.0% and 80.0% respectively, the three parameters were all higher than those in Group Ⅱ (75.0%, 46.4% and 42.9% respectively). Moreover, the EP recurrence rate in Group Ⅰ was lower than that in Group Ⅱ (4.0% vs 14.2%), the serum β-hCG normalizing time and total disappearance time of EP mass in Group Ⅰ (25.0±7.8 days and 1.2±0.7 months) were shorter than those in Group Ⅱ (31.9±6.7 days and 5.6±3.7 months), also showing significant difference (P<0.05 and P<0.01 respectively). After being treated by EP2 decoction for 4-8 weeks, the hemorrheological parameters in Group Ⅰ were improved more markedly than those in Group Ⅱ. Conclusion: The TCM-WM treatment (MTX plus EP2) could effectively increase nonsurgical cure rate, tubal patency rate and intrauterine pregnancy rate, decrease EP recurrence rate, and reduce the serum β-hCG normalizing time and the total disappearance time of EP mass in treating EP.

Negative Pregnancy Test—Can It Confidently Rule out an Ectopic?

We have presented an unusual case of ectopic pregnancy with the negative urinary pregnancy test and a very low level of serum beta-hCG (11 IU/L). Ultrasound scan revealed right adnexal mass. Medical management and laparoscopic salpingectomy allowed for a favourable outcome.

甲氨蝶呤治疗异位妊娠的真实世界数据分析

目的:通过对临床上甲氨蝶呤(MTX)治疗异位妊娠病例的研究,了解真实世界里MTX肌肉注射治疗异位妊娠的临床现状,以更好地指导临床规范合理治疗。方法:以2016年1月至2020年12月间南京医科大学附属妇产医院妇科电子病历为数据来源,对MTX肌肉注射治疗异位妊娠患者的临床资料进行分析。结果:临床上总药物治疗成功率为81.3%,大多数使用单剂量MTX肌肉注射治疗方案,实际使用剂量大多数低于标准剂量(50 mg·m^(-2)),并且实际使用剂量的差别对成功率没有影响。治疗后的随诊并不完全符合规范。治疗前血清β绒毛促性腺激素(β-hCG)值越高,MTX单次注射治疗的成功率越低(OR=0.638);停经天数(末次月经到注射MTX时间)越长,MTX单次注射治疗的成功率越高(OR=1.570)。成功组在注射后4~7 d血β-hCG值下降均显著高于失败组,但在第2、3天与失败组差异无统计学意义。结论:临床工作中异位妊娠药物治疗的管理规范并未被严格执行,需要更多关注。注射前越低的血β-hCG值及越长的停经天数是单次MTX治疗成功的重要预测因素。注射后第2、3天复查血β-hCG值对是否需要后继治疗无良好的预测价值。

化瘀杀胚汤联合甲氨蝶呤治疗异位妊娠的疗效及对TGF-β/Smad2/3蛋白水平和microRNA-30d-5p表达量的影响

【目的】探讨化瘀杀胚汤(由丹参、赤芍、桃仁、蜈蚣、紫草、天花粉、三七等中药组成)联合甲氨蝶呤治疗异位妊娠疗效及对患者TGF-β/Smad2/3蛋白水平和microRNA-30d-5p表达量的影响。【方法】将104例异位妊娠患者随机分为观察组和对照组,每组各52例。对照组给予甲氨蝶呤联合米非司酮治疗,观察组在对照组的基础上加用化瘀杀胚汤治疗,连续用药3 d并随访观察1个月。比较2组患者保守治疗成功率、血β人绒毛膜促性腺激素(β-HCG)水平恢复正常时间以及异位妊娠包块吸收时间、治疗后输卵管完全通畅率与不通畅率,观察2组保守治疗成功患者治疗前后血清TGF-β/Smad2/3蛋白水平和microRNA-30d-5p相对表达量的变化情况。【结果】(1)观察组的保守治疗成功率为94.23%(49/52),明显高于对照组的71.15%(37/52),差异有统计学意义(P<0.05)。(2)与对照组比较,观察组的血β-HCG恢复正常时间及包块吸收时间均明显缩短,差异均有统计学意义(P<0.01)。(3)观察组治疗后的输卵管完全通畅率为55.77%(29/52),明显高于对照组的21.15%(11/52);不通畅率为19.23%(10/52),明显低于对照组的59.62%(31/52),差异均有统计学意义(P<0.05或P<0.01)。(4)与治疗前比较,2组保守治疗成功患者治疗结束1个月后的TGF-β/Smad2/3蛋白水平和microRNA-30d-5p相对表达量均明显降低(P<0.05或P<0.01);与对照组比较,观察组治疗结束1个月后的TGF-β/Smad2/3蛋白水平和microRNA-30d-5p相对表达量均明显降低,差异均有统计学意义(P<0.01)。(5)2组患者的不良反应均以胃肠道不适为主,观察组的不良反应发生率为25.00%(13/52),明显低于对照组的46.15%(24/52),组间比较,差异有统计学意义(P<0.05)。【结论】化瘀杀胚汤联合甲氨蝶呤治疗异位妊娠,可有效提高药物保守治疗的成功率,有助于包块的吸收以及输卵管通畅,能有效降低患者的TGF-β/Smad2/3蛋白水平及microRNA-30d-5p的相对表达量,且药物安全性较高。

超声引导下甲氨蝶呤局部注射联合米非司酮治疗未破裂型输卵管妊娠的临床效果

目的观察超声引导下甲氨蝶呤局部注射联合米非司酮治疗未破裂型输卵管妊娠的临床效果。方法选取2022年9月至2023年12月内蒙古科技大学包头医学院第一附属医院收治的60例未破裂型输卵管妊娠患者作为研究对象,采用随机数字表法分为对照组与观察组,每组30例。对照组采用口服米非司酮治疗,观察组采用超声引导下向未破裂输卵管妊娠囊内注射甲氨蝶呤+口服米非司酮治疗。比较两组β-人绒毛膜促性腺激素(β-HCG)水平、治疗总有效率及不良反应总发生率。结果观察组治疗后3、6d的β-HCG水平低于对照组(P<0.05);观察组治疗总有效率高于对照组(P<0.05);观察组不良反应总发生率为6.67%,低于对照组的30.00%(P<0.05)。结论超声引导下甲氨蝶呤局部注射联合米非司酮治疗未破裂型输卵管妊娠的临床效果显著,能够促进β-HCG水平的恢复,减少不良反应,值得推广。

米非司酮联合甲氨蝶呤治疗输卵管异位妊娠的临床效果及对血清生化指标的影响

目的观察米非司酮联合甲氨蝶呤治疗输卵管异位妊娠的临床效果及对患者血清生化指标的影响。方法选取2021年1—2023年1月厦门大学附属妇女儿童医院收治的输卵管异位妊娠患者86例,采用抽签法分为米非司酮联合组和甲氨蝶呤组各43例。甲氨蝶呤组给予甲氨蝶呤治疗,米非司酮联合组给予米非司酮联合甲氨蝶呤治疗,2组均治疗5 d。比较2组治疗效果、症状改善时间,治疗前后血清生化指标[血β-人绒毛膜促性腺激素(β-hCG)、血管内皮生长因子(VEGF)]、凝血功能指标[活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、血小板计数(PLT)]、女性性功能指数(FSFI)评分、生活质量综合评定问卷(GQOLI-74)评分,不良反应。结果米非司酮联合组治疗成功率为93.02%,高于甲氨蝶呤组的74.42%(χ^(2)=5.460,P=0.019);米非司酮联合组包块消失时间、β-hCG转阴时间、盆腔积液消失时间、腹痛消失时间及月经复潮时间均短于甲氨蝶呤组(P<0.01)。治疗后4周,2组β-hCG及VEGF水平均较治疗前降低,且米非司酮联合组低于甲氨蝶呤组(P<0.01);2组APTT较治疗前缩短,PLT较治疗前降低,Fib水平较治疗前升高,且米非司酮联合组变化幅度大于甲氨蝶呤组(P<0.01);2组FSFI及GQOLI-74评分较治疗前升高,且米非司酮联合组高于甲氨蝶呤组(P<0.01)。米非司酮联合组不良反应总发生率为6.98%,甲氨蝶呤组不良反应总发生率为2.33%,2组不良反应总发生率比较差异无统计学意义(χ^(2)=0.262,P=0.609)。结论米非司酮联合甲氨蝶呤治疗输卵管异位妊娠的效果较好,可提高治疗成功率,流产后症状恢复时间更短,可调节患者血清学指标,保障后期生活质量。

复方米非司酮联合桂枝茯苓胶囊应用于异位妊娠的临床观察

目的探讨复方米非司酮联合桂枝茯苓胶囊应用于异位妊娠的临床观察。方法该研究进行前瞻性研究的方式,总计选取2019年1月—2022年5月于该院进行诊治的异位妊娠(输卵管妊娠)女性136例,将其作为干预对象。收集患者的资料,依据随机数字表编号方法,均分入两组各有68例。对照组予以复方米非司酮治疗;观察组予以复方米非司酮联合桂枝茯苓胶囊治疗。治疗4周后比较两组患者的临床疗效,记录两组患者的阴道流血消失时间、包块消失时间、月经恢复正常时间及血清β绒毛膜促性腺激素(β-HCG)转阴时间,治疗前及治疗4周抽取患者的血液样本,测定血清β-HCG、雌二醇(E_(2))、孕酮及肿瘤坏死因子(TNF-α)和白细胞介素(IL-8)水平。结果对照组患者的总有效率[85.29%(58/68)]低于观察组[95.59%(65/68)],差异有统计学意义(P<0.05)。对照组患者的阴道流血消失时间、包块消失时间月经恢复正常时间及血清β-HCG转阴时间,均高于观察组,差异有统计学意义(P<0.05)。与治疗前比,两组治疗4周血清β-HCG、E_(2)和孕酮水平均下降,并且观察组治疗4周血清β-HCG和孕酮水平低于对照组,差异有统计学意义(P<0.05)。与治疗前比,两组治疗4周血清TNF-α、IL-8水平均下降,并且观察组治疗4周血清TNF-α、IL-8水平均低于对照组,差异有统计学意义(P<0.05)。结论复方米非司酮联合桂枝茯苓胶囊可以提高异位妊娠的临床疗效,缩短恢复时间,改善性激素水平及减少炎症因子,值得大力推广。

416例异位妊娠患者行甲氨蝶呤单次注射的治疗结局及影响因素分析

目的探讨甲氨蝶呤(methotrexate,MTX)单次注射治疗异位妊娠的结局及相关影响因素。方法回顾性分析2019年1月至2022年12月在复旦大学附属妇产科医院住院的416例异位妊娠患者,均行MTX单次注射,用药当天记为第1天,在用药第4天和第7天复查血β-人绒毛膜促性腺激素(β-human chorionic gonadotrophin,β-hCG)。与第4天相比,第7天血β-人绒毛膜促性腺激素下降<15%为治疗失败,纳入失败组;第7天血β-hCG下降>15%,为初始治疗有效,继续随访直至β-hCG下降至正常水平,纳入成功组。收集两组患者基线信息和治疗结局,并分析与治疗结局相关的影响因素。结果失败组纳入70例,成功组纳入346例。失败组中用药前β-hCG上升人数比例显著高于成功组(55.2%vs.35.8%,P=0.007),用药前β-hCG下降人数比例显著低于成功组(43.1%vs.63.6%,P=0.007)。失败组单核细胞计数显著低于成功组[(0.43±0.13)×10^(9)/L vs.(0.47±0.17)×10^(9)/L,t=-2.001,P=0.047)]。两组用药前β-hCG、β-hCG变化速度、白蛋白、血肌酐、白细胞计数、中性粒细胞计数、血小板平均体积、中性粒细胞-淋巴细胞比值、血小板-淋巴细胞比值、淋巴细胞-单核细胞比值的差异均无统计学意义。Logistic回归分析表明治疗结局与用药前β-hCG变化方式和单核细胞计数有关,用药前β-hCG下降(OR=2.313,95%CI:1.222~4.379,P=0.010)和单核细胞计数≥0.6×10^(9)/L(OR=4.018,95%CI:1.207~13.378,P=0.023)对治疗结局有显著影响。结论用药前β-hCG下降和单核细胞计数≥0.6×10^(9)/L是MTX单次注射成功治疗异位妊娠的独立影响因素。

低剂量米非司酮辅助甲氨蝶呤治疗未破裂异位妊娠的效果及可行性研究

目的研究低剂量米非司酮辅助甲氨蝶呤治疗未破裂异位妊娠的效果及可行性。方法选取我院2021年2月到2023年2月期间接诊的90例未破裂异位妊娠患者作为研究对象。按照随机数表法分为研究组与对照组各45例。对照组给予甲氨蝶呤治疗,研究组给予低剂量米非司酮辅助甲氨蝶呤治疗。两组患者均连续治疗7d,记录并比较两组患者的治疗效果、治疗前后包块直径、血β-人绒毛膜促性腺激素(β-HCG)值、临床症状改善时间(盆腔包块减小时间、腹痛消失时间、β-HCG水平降低时间)及药物不良反应发生情况。结果研究组患者的总有效率为95.56%,明显高于对照组患者的82.22%(P<0.05);两组患者的包块直径、血β-HCG值在治疗前相比,差异无统计学意义(P>0.05),两组患者治疗后的包块直径、血β-HCG值较治疗前均明显降低,且研究组明显低于对照组(P<0.05);研究组患者的盆腔包块减小时间、腹痛消失时间、β-HCG水平降低时间均明显低于对照组,差异有统计学意义(P<0.05);药物不良反应方面,研究组(15.56%)稍高于对照组(8.89%),但无明显差异(P>0.05)。结论低剂量米非司酮辅助甲氨蝶呤治疗未破裂异位妊娠效果显著,可有效缩短患者临床症状改善时间,有利于降低血β-HCG水平,且安全性高,具有临床应用价值,值得推广。

单次大剂量氨甲蝶呤联合米非司酮治疗异位妊娠患者的效果

目的:观察单次大剂量氨甲蝶呤联合米非司酮治疗异位妊娠患者的效果。方法:回顾性分析2021年1月至2023年12月该院收治的70例异位妊娠患者的临床资料,按氨甲蝶呤注射液给药方案不同分为观察组和对照组各35例。观察组采用单次大剂量氨甲蝶呤联合米非司酮治疗,对照组采用多次小剂量氨甲蝶呤联合米非司酮治疗,比较两组β-人绒毛膜促性腺激素(β-HCG)转阴时间、包块消失时间、月经复潮时间、实验室指标[血管内皮生长因子(VEGF)、抑制素(INH-A)、妊娠相关血浆蛋白-A(PAPP-A)]水平、性激素指标(β-HCG、雌二醇、孕酮)水平和不良反应发生率。结果:观察组β-HCG转阴时间、包块消失时间均短于对照组,差异有统计学意义(P<0.05);治疗后,两组血清VEGF、INH-A、PAPP-A等实验室指标和β-HCG、雌二醇、孕酮等性激素指标水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组月经复潮时间和不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:单次大剂量氨甲蝶呤联合米非司酮治疗异位妊娠患者可缩短β-HCG转阴时间和包块消失时间,降低实验室指标和性激素指标水平,效果优于多次小剂量氨甲蝶呤联合米非司酮治疗。

宫外孕方联合甲氨蝶呤+米非司酮对输卵管妊娠患者β-人绒毛膜促性腺激素及肌酸激酶水平的影响

目的探究宫外孕方联合甲氨蝶呤+米非司酮对输卵管妊娠患者β-人绒毛膜促性腺激素(β-HCG)及肌酸激酶(CK)水平的影响。方法回顾性选取浙江省宁海县妇幼保健院2022年1月至2023年12月收治的输卵管妊娠患者126例,将研究对象按是否使用宫外孕方治疗分为观察组和对照组各63例,观察组采用宫外孕方联合甲氨蝶呤+米非司酮治疗,对照组采用甲氨蝶呤+米非司酮治疗。比较2组患者的临床疗效,血清β-HCG及CK水平,血清β-HCG恢复正常及包块消失的时间,以及不良反应情况。结果观察组总有效率为94%,对照组总有效率为76%,相比差异有统计意义(χ^(2)=4.771,P=0.021);干预后2组血清β-HCG、CK水平均下降(P<0.001),观察组干预后4 d、7 d和14 d的血清β-HCG、CK水平均低于对照组,差异有统计意义(t值分别为6.117、7.462、14.001,2.996、3.402、7.569;P均<0.001);观察组血清β-HCG恢复正常时间和包块消失时间均短于对照组,相比差异有统计意义(t=4.417、7.122,P均<0.001);观察组不良反应总发生率为49%,对照组不良反应总发生率为81%,相比差异有统计意义(χ^(2)=5.779,P=0.018)。结论宫外孕方联合甲氨蝶呤+米非司酮更有利于改善输卵管妊娠患者血清β-HCG及CK水平,缩短血清β-HCG转阴时间及包块消失时间,降低不良反应发生率,总体疗效更显著,值得临床予以推广应用。

桃红四物汤加味结合甲氨蝶呤对异位妊娠患者的影响

目的:探讨桃红四物汤加味结合甲氨蝶呤对异位妊娠患者的影响。方法:回顾性选取2018年1月—2022年12月北京怀柔医院收治的80例异位妊娠患者作为研究对象。根据治疗方案的不同将其分为对照组(38例)及联合组(42例)。对照组给予甲氨蝶呤注射液,联合组在对照组基础上给予桃红四物汤加味治疗。比较两组临床疗效,时间指标及治疗前、治疗15 d后血清学指标,生殖潜能。结果:联合组临床疗效优于对照组,总有效率高于对照组,差异有统计学意义(P<0.05)。联合组包块吸收时间和血清β-绒毛膜促性腺激素(β-human chorionic gonadotophin,β-hCG)恢复正常时间均明显早于对照组,差异有统计学意义(P<0.05)。治疗15 d后,两组抗米勒管激素(anti-Müllerian hormone,AMH)水平降低,谷丙转氨酶(alanine transaminase,ALT)及血清尿素氮(blood urea nitrogen,BUN)水平均升高,联合组AMH水平高于对照组,ALT及BUN水平均低于对照组,差异有统计学意义(P<0.05)。联合组随访1年再次宫内妊娠率明显高于对照组,未孕率明显低于对照组,差异有统计学意义(P<0.05)。结论:桃红四物汤加味结合甲氨蝶呤能够提高异位妊娠疗效,促进患者包块缩小及血清β-hCG下降,有助于减轻卵巢功能及肝肾功能损伤,并提高患者生殖潜能。