Abstract:
Ectopic pregnancy (EP) is the implantation of an embryo outside the endometrial cavity of the uterus. Signs and symptoms of EP may arise between the 6th and the 8th week of gestation and include vaginal bleeding, lower abdominal and pelvic pain. Frequently EPs implant in the fallopian tubes. A rare EP is the interstitial pregnancy, a life-threatening condition being responsible for nearly 20% of all deaths caused by EPs. Because of its unique location, the diagnosis is difficult and based on signs and specific criteria together with measuring of serum β-hCG. Usually, EP is treated by surgical approach, which is associated with increased morbidity, decreased fertility and increased likelihood of hysterectomy and uterine rupture in a subsequent pregnancy. Early diagnosis is crucial to life saving and allowing alternative therapeutic interventions such as pharmacological treatments. Methotrexate (MTX) represents the mainstay therapy. There is no standard care for the interstitial pregnancy for what concerns either surgical or pharmacological approaches. We reported a case of a 36-year-old woman admitted to the Hospital of Salerno-Italy with a value of serum β-hCG of 35,993 IU/L. Transvaginal ultrasonography revealed an empty uterine cavity and a mass of 35.7 mm in diameter characterized by a hypoechoic central area. The patient was in stable haemodynamic condition and no haematologic, renal and hepatic impairments were recorded. Despite the high serum β-hCG levels, a pharmacological approach was preferred to a surgical one. The patient was treated with intramuscular administration of MTX in daily dose of 1 mg/Kg alternated with 0.1 mg/kg folinic acid for 5 days. The patient remained hospitalized for 20 days and no side effects were reported. The decrease of the serum β-hCG was monitored and more than 15% reduction was detected between the 4th and the 7th day after the beginning of the treatment. The serum β-hCG became undetectable 35 days after. A multidosing intramuscular administration of MTX was effective and safe even in the presence of very high serum β-hCG levels. Together with similar cases reported in literature, the present results can contribute to improve the decision making in the treatment of the interstitial pregnancy.
摘要:
异位妊娠(EP)是将胚胎植入子宫内膜腔外。EP的体征和症状可能出现在妊娠的第6周和第8周之间,包括阴道出血,下腹部和骨盆疼痛。经常在输卵管中植入EP。一种罕见的EP是间质妊娠,一种危及生命的疾病是导致EP造成的所有死亡的近20%。由于其独特的地理位置,诊断是困难的,并且基于体征和特定标准以及血清β-hCG的测量。通常,EP通过手术方法治疗,这与发病率增加有关,生育能力下降,随后妊娠子宫切除术和子宫破裂的可能性增加。早期诊断对于挽救生命和允许替代治疗干预如药物治疗至关重要。甲氨蝶呤(MTX)是主要的治疗方法。对于涉及手术或药理方法的间质妊娠,没有标准的护理。我们报告了一名36岁的妇女在意大利萨勒诺医院住院,血清β-hCG值为35,993IU/L。经阴道超声检查显示子宫腔空,直径为35.7毫米,其特征是中央区域低回声。患者血流动力学状况稳定,无血液学,记录肾和肝损伤.尽管血清β-hCG水平很高,药理学方法优于外科手术。患者通过以1mg/Kg的日剂量肌内施用MTX与0.1mg/kg亚叶酸交替治疗5天。患者住院20天,无副作用报告。监测血清β-hCG的降低,并且在治疗开始后的第4天和第7天之间检测到超过15%的降低。血清β-hCG在35天后变得不可检测。即使在存在非常高的血清β-hCG水平的情况下,MTX的多剂量肌内给药也是有效且安全的。加上文献中报道的类似病例,本研究结果有助于改善间质妊娠治疗的决策。