目的探讨分析甲氨蝶呤联合米非司酮治疗异位妊娠130例的临床疗效。方法以随机数字表法将2014年1月~2014年12月在辽宁医学院附属第一医院妇产科住院的130例异位妊娠患者,随机分为对照组和观察组,每组65例。对照组异位妊娠患者给予甲氨蝶...目的探讨分析甲氨蝶呤联合米非司酮治疗异位妊娠130例的临床疗效。方法以随机数字表法将2014年1月~2014年12月在辽宁医学院附属第一医院妇产科住院的130例异位妊娠患者,随机分为对照组和观察组,每组65例。对照组异位妊娠患者给予甲氨蝶呤1 mg/kg肌肉注射,每天1次;观察组给予甲氨蝶呤联合米非司酮治疗,米非司酮口服75 mg/次,每天1次。对比分析2组患者经治疗后的血清人绒毛膜促性腺激素β亚基（β-subunit of human chorionic gonadotropin,β-h CG）、正常妊娠率﹑异位妊娠包块缩小幅度﹑治疗成功率及并发症发生状况。结果观察组血清β-HCG恢复到正常值所需的时间显著短于对照组（P〈0.05）,正常妊娠率显著高于对照组（χ2=15.93,P〈0.05）。治疗7 d、14 d,观察组异位妊娠患者异位妊娠包块直径缩小的幅度均显著大于对照组（P〈0.05）。经2个月治疗,2组异位妊娠患者治疗后观察组有效率（92.31%）显著高于对照组（61.54%）（χ2=17.33,P〈0.05）。2组不良反应发生率比较差异无统计学意义（χ2=0.34,P〉0.05）。结论甲氨蝶呤联合米非司酮治疗异位妊娠可以有效提高临床疗效,不良反应较少,安全性较高。展开更多
This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the dia...This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.展开更多
Background Heterotopic cesarean scar pregnancy （HCSP） is a very rare but life-threatening entity and there is no optimal management strategy. Here we report a successfully managed case of HCSP with expectant treatme...Background Heterotopic cesarean scar pregnancy （HCSP） is a very rare but life-threatening entity and there is no optimal management strategy. Here we report a successfully managed case of HCSP with expectant treatment in a tertiary referral hospital. Methods A woman with HCSP after in vitro fertilization-embryo transfer opted for expectant treatment after five days of mild bleeding and ultrasound demonstrated cardiac activity disappearance of the scar pregnancy at 8＋4 weeks of gestation. Results The patient had mild to moderate bleeding during close monitoring. Three days later, speculum examination revealed the gestational mass was partly protruding at the os of the cervix and it was removed with forceps without massive hemorrhage. A healthy male baby was delivered by cesarean section at gestational age of 36＋4 weeks. Conclusions The expectant method might be an alternative option for a HCSP with loss of cardiac activity of the scar pregnancy, when applied under supportive management and with available emergency surgery facilities.展开更多
Background Heterotopic pregnancy （HP） is defined as a pregnancy in which one or more embryos is viably implanted in the uterus while the other is implanted elsewhere as an ectopic pregnancy. The occurrence of HP ris...Background Heterotopic pregnancy （HP） is defined as a pregnancy in which one or more embryos is viably implanted in the uterus while the other is implanted elsewhere as an ectopic pregnancy. The occurrence of HP rises dramatically with the increased use of assisted reproductive technology. HP of interstitial pregnancy is one special situation which needs more concern. Here we evaluate the efficacy of local aspiration and instillation of hyperosmolar glucose in the treatment of live interstitial pregnancy complicated with live intrauterine pregnancy after in vitro fertilization and embryo transfer. Methods Five female patients were diagnosed with live interstitial pregnancies complicated with intrauterine pregnancies. They were treated with transvaginal ultrasound-guided aspiration of interstitial pregnancy and instillation of hyperosmolar glucose at the Center for Reproductive Medicine of Peking University Third Hospital from January 1st, 2008 to May 30th, 2011. Results Gemmule embryos in all 5 cases were aspirated successfully and there was no abdominal hemorrhage, threatened abortion or infection in any of the cases. The sac of interstitial pregnancy continued to progress after aspiration and stopped growing between 11 to 20 weeks. By the 30th week of pregnancy, 80% of the interstitial masses had disappeared. Four cases have delivered and one is still in on-going pregnancy. All of the four cases underwent cesarean section and there were nothing special detected in the corner of the uterus. Conclusion Local aspiration and instillation of hyperosmolar glucose may be an effective way to treat live interstitial pregnancy when coexisting with a live intrauterine pregnancy.展开更多
文摘目的探讨分析甲氨蝶呤联合米非司酮治疗异位妊娠130例的临床疗效。方法以随机数字表法将2014年1月~2014年12月在辽宁医学院附属第一医院妇产科住院的130例异位妊娠患者,随机分为对照组和观察组,每组65例。对照组异位妊娠患者给予甲氨蝶呤1 mg/kg肌肉注射,每天1次;观察组给予甲氨蝶呤联合米非司酮治疗,米非司酮口服75 mg/次,每天1次。对比分析2组患者经治疗后的血清人绒毛膜促性腺激素β亚基（β-subunit of human chorionic gonadotropin,β-h CG）、正常妊娠率﹑异位妊娠包块缩小幅度﹑治疗成功率及并发症发生状况。结果观察组血清β-HCG恢复到正常值所需的时间显著短于对照组（P〈0.05）,正常妊娠率显著高于对照组（χ2=15.93,P〈0.05）。治疗7 d、14 d,观察组异位妊娠患者异位妊娠包块直径缩小的幅度均显著大于对照组（P〈0.05）。经2个月治疗,2组异位妊娠患者治疗后观察组有效率（92.31%）显著高于对照组（61.54%）（χ2=17.33,P〈0.05）。2组不良反应发生率比较差异无统计学意义（χ2=0.34,P〉0.05）。结论甲氨蝶呤联合米非司酮治疗异位妊娠可以有效提高临床疗效,不良反应较少,安全性较高。
基金supported by the National Natural Science Foundation of China(No.81170574)the National Key Basic Research Development Plan of China(973 Program)(No.2007CB948104)+1 种基金Key Science and Technology Projects of Guangzhou(No.11C22120737)Comprehensive Strategic Sciences Cooperation Projects of Guangdong Province and Chinese Academy(No.04020416)
文摘This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.
文摘Background Heterotopic cesarean scar pregnancy （HCSP） is a very rare but life-threatening entity and there is no optimal management strategy. Here we report a successfully managed case of HCSP with expectant treatment in a tertiary referral hospital. Methods A woman with HCSP after in vitro fertilization-embryo transfer opted for expectant treatment after five days of mild bleeding and ultrasound demonstrated cardiac activity disappearance of the scar pregnancy at 8＋4 weeks of gestation. Results The patient had mild to moderate bleeding during close monitoring. Three days later, speculum examination revealed the gestational mass was partly protruding at the os of the cervix and it was removed with forceps without massive hemorrhage. A healthy male baby was delivered by cesarean section at gestational age of 36＋4 weeks. Conclusions The expectant method might be an alternative option for a HCSP with loss of cardiac activity of the scar pregnancy, when applied under supportive management and with available emergency surgery facilities.
文摘Background Heterotopic pregnancy （HP） is defined as a pregnancy in which one or more embryos is viably implanted in the uterus while the other is implanted elsewhere as an ectopic pregnancy. The occurrence of HP rises dramatically with the increased use of assisted reproductive technology. HP of interstitial pregnancy is one special situation which needs more concern. Here we evaluate the efficacy of local aspiration and instillation of hyperosmolar glucose in the treatment of live interstitial pregnancy complicated with live intrauterine pregnancy after in vitro fertilization and embryo transfer. Methods Five female patients were diagnosed with live interstitial pregnancies complicated with intrauterine pregnancies. They were treated with transvaginal ultrasound-guided aspiration of interstitial pregnancy and instillation of hyperosmolar glucose at the Center for Reproductive Medicine of Peking University Third Hospital from January 1st, 2008 to May 30th, 2011. Results Gemmule embryos in all 5 cases were aspirated successfully and there was no abdominal hemorrhage, threatened abortion or infection in any of the cases. The sac of interstitial pregnancy continued to progress after aspiration and stopped growing between 11 to 20 weeks. By the 30th week of pregnancy, 80% of the interstitial masses had disappeared. Four cases have delivered and one is still in on-going pregnancy. All of the four cases underwent cesarean section and there were nothing special detected in the corner of the uterus. Conclusion Local aspiration and instillation of hyperosmolar glucose may be an effective way to treat live interstitial pregnancy when coexisting with a live intrauterine pregnancy.
