Chemotherapy for ectopic pregnancy

Chemotherapy for ectopic pregnancy is a new minimally invasive surgery. The treatment method is to insert a catheter through the femoral artery in the thigh, find the site of ectopic pregnancy through the catheter, and then inject a small dose of chemotherapy drugs to achieve the purpose of surgery. Generally, systemic medication is used, and local medication can also be used.

Indications

Chemotherapy is suitable for young patients with early ectopic pregnancy who want to preserve their fertility. Chemotherapy can be used if the following conditions are met:

The diameter of the tubal pregnancy mass is <3cm; the tubal pregnancy has not ruptured or miscarried; there is no obvious internal bleeding; the blood human chorionic gonadotropin (HCG) is <2000U/L.

Systemic medication

Methotrexate (MTX) is commonly used for systemic medication. The treatment mechanism is to inhibit trophoblast proliferation, destroy villi, and cause embryonic tissue necrosis, shedding, and absorption to avoid surgery. The commonly used dose is 0.4 mg/kg·d, intramuscular injection, and a course of treatment is 5 days. The application of chemotherapy may not be successful in every case, so B-ultrasound and HCG should be used for close monitoring during treatment, and attention should be paid to changes in the patient's condition and the toxic and side effects of the drug. If HCG decreases 14 days after medication and is negative for 3 consecutive times, abdominal pain is relieved or disappears, and vaginal bleeding is reduced or stopped, it is considered to be effective. If the condition does not improve, or even acute abdominal pain or fallopian tube rupture symptoms occur, surgical treatment should be performed immediately.

Topical medications

For local medication, the drug can be directly injected into the gestational sac of the fallopian tube by puncture under the guidance of B-type ultrasound, or the gestational sac of the fallopian tube can be punctured under direct laparoscopic vision, and the drug can be injected into it after some of the cystic fluid is sucked out. Currently, the commonly used drug is still MTX.