Integrative Treatment of Ectopic Pregnancy: 48 Cases
[Article ID] 1008-8164 (2004)
Ectopic pregnancy is a common acute abdomen in obstetrics and gynecology. In recent years, the incidence rate has shown an upward trend year by year. Although surgical treatment is available, it poses urgent fertility requirements for women due to the contralateral oviduct often having lesions. Resection can reduce the chances of future pregnancy. In the past four years, our hospital treated 182 cases of ectopic pregnancy patients, among which 48 cases were treated with a combination of Chinese and Western medicine, achieving good results. These are reported as follows:
1. Materials and Methods
1.1 Clinical Data
From January 2000 to December 2003, a total of 182 cases of ectopic pregnancy were admitted to our hospital. Each patient was diagnosed based on clinical symptoms, signs, blood, urine HCG detection, culdocentesis B-ultrasound, and curettage. Among them, 48 cases of ectopic pregnancy were treated with Western medicine combined with treatment. The age range was 20 to 38 years, with an average age of 26.
Treatment conditions:
① Patients with hemodynamic stability;
② Adnexal mass diameter <3 cm;
③ Tubal pregnancy does not rupture or abort;
④ No obvious bleeding, vital signs were stable;
⑤ Blood β-HCG <2000u/L;
⑥ Normal liver and kidney function, voluntary request for conservative medical treatment.
After improving auxiliary examinations,
1.2 Methods
The hospital checked the liver, renal function, ECG abnormalities, drug contraindications, and observed stable vital signs. Methotrexate (MTX) was administered at a dose of 20mg intramuscular injection once a day, for a course of 5 days, plus Chinese herb therapy. Prescription included: Danshen 15g, red peony root 15g, peach kernel 15g, frankincense 10g, myrrh 15g, three shuttle 10g, Curcuma 10g, trichosanthin 12g (or centipede), Yuan Hu 10g, Toosendan 10g, Chinese angelica 15g. A day's water served five times, for a treatment course of 5 days.
1.3 Evaluation of Treatment
Each course of treatment reviewed pelvic B-ultrasound and urine HCG or β-HCG, paying close attention to the patient’s vital signs, abdominal pain, vaginal bleeding, and drug toxicity. The patient was required to rest in bed and maintain smooth bowel movements.
Cure: Symptoms disappeared, normal gynecological examination, urine HCG was negative, β-HCG dropped to 3 consecutive negatives, reduction or cessation of vaginal bleeding, B-ultrasound tip annex area mass disappears.
Improved: Symptoms decreased, β-HCG package block reduced, continue to use traditional Chinese medicine; β-HCG decline is not obvious, mass without narrowing, vital signs of patients balanced in a stable condition, pelvic (abdominal) cavity effusion, Chinese medicine feasible course of treatment, MTX underwent the next course of treatment after an interval of 5 days.
In the course of treatment, if patients present with acute abdominal pain accompanied by anal heaviness, the adnexal mass increases, pelvic (abdominal) cavity effusion, OK vaginal blood was drawn during culdocentesis, consider ruptured ectopic pregnancy or abortion possibility. If the treatment may be ineffective, surgical treatment should be immediately considered.
2. Results and Analysis
Among the 48 patients, 40 cases showed urinary HCG and β-HCG negativity via B-super prompt mass shrinking or disappearing, with the mass disappearing upon review in January after B-prompted mass. Four cases required 2 treatments with MTX, with the February B-ultrasound prompting mass disappearance. In 4 patients during the treatment process, acute abdominal pain and anal heaviness occurred, with blood drawn from the culdocentesis line in the vagina leading to emergency surgery. Intraoperative bleeding exceeded 500ml in one case, while the remaining three cases had 200~400ml. Clinical observations indicated a treatment success rate of 91.7%.
Combination of Western Medicine treatment for ectopic pregnancy reduces surgical complications, increases the opportunity for patients requiring fertility to become pregnant again, and avoids sterility. MTX combined with Chinese medicine has shown significant effects through clinical observation. MTX inhibits the proliferation of trophoblast cells, damages the villi, enabling ectopic pregnancy embryonic tissue necrosis and absorption. Traditional Chinese medicine mainly promotes blood circulation and eliminates disease. MTX interferes with trophoblast cell DNA synthesis, inducing cell death and stopping development. The use of traditional Chinese medicine (TCM) improves local blood circulation, kills the embryo with medicinal action, further prevents the growth of trophoblast cells and embryos, and under favorable blood circulation significantly improves efficiency. Two-drug treatment does not destroy the tubal wall tissue and repair function, bringing hope to patients who need to preserve fertility.
As reported in similar studies, treatment for ectopic pregnancy in patients aiming to preserve fertility focuses on early ectopic pregnancies, especially young patients requiring fertility preservation, making it a preferred method for women seeking fertility and reducing their economic burden. Its inadequacies include longer treatment durations, where patients might lack patience and abandon treatment opportunities.
[Received date: 2004-02-23]