Abstract
Methotrexate has been the main mode of non-surgical treatment for ectopic pregnancies. However, we have developed an easier, repeatable method that can be applied even to patients with a high beta-human chorionic gonadotropin (β-hCG) level and/or positive fetal heartbeat, by targeting chorionic villi with a transvaginal injection of absolute ethanol (AE) into the lacunar space (intervillous space). The efficacy and safety of this method were examined in 242 cases of ectopic pregnancy, including 103 with positive fetal heartbeat. Serum β-hCG level was measured at frequent intervals, and transvaginal ultrasonography was performed to observe the gestational sac and hyperechoic inner ring. Of the 242 patients, 222 (91.7%) were successfully treated. The average number of AE injection(s) required was 1.6 (range: 1–5), and the average dose was 3.2 mL. After the treatment, many of the patients tried to conceive again, and 63 of the traceable 145 patients (43.4%), who had fallopian tube pregnancy, and 7 of the traceable 12 patients (58.3%), who had cervical or cesarean scar pregnancies, successfully conceived and delivered babies with no observed side effects. Therefore, this method could be an effective treatment for ectopic pregnancy with the potential to replace conventional surgical interventions and medical treatment using methotrexate.
Highlights
Ectopic pregnancies (EP), which account for approximately 2% of all pregnancies, can seriously compromise a patient’s health and future fertility [1,2]
EP is a disease identified in women at an early stage of pregnancy, and is an absolute indication for surgery, since it is a serious risk factor for maternal mortality owing to acute abdomen [3,4]
In cervical pregnancy (CP) and cesarean section scar pregnancy (CSSP), in particular, trophoblast cells may invade the cervical wall and cervical blood vessels, and interventions such as dilatation and curettage might be associated with a high risk of rupture, severe bleeding, and hemodynamic collapse [12]
Summary
Ectopic pregnancies (EP), which account for approximately 2% of all pregnancies, can seriously compromise a patient’s health and future fertility [1,2]. CP and CSSP are rare, with reported incidences of 1 in 1000 to 95,000 pregnancies [3], and 1 in approximately 2000 in patients with previous CSSP [4], respectively. They are among the most difficult conditions to treat, and hysterectomy or uterine artery embolization is often necessary. Local injection of MTX is an effective technique for preserving fertility in women with lower uterine EP, and Yamaguchi et al [6] reported a success rate of 100% in this regard
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
