Analysis Of Clinical Effects Of Different Medical Treatments For Ectopic Pregnancy

BackgroundEctopic pregnancy is a common acute disease in obstetrics and gynecology.The incidence is about 2%,and tubal pregnancy accounts for more than 95%,which is one of the causes of maternal mortality.In recent years,with the development of high-sensitivity radioimmunoassay techniques such as human chorionic gonadotropin and high-resolution vaginal ultrasound,the rate of diagnosis of early unruptured ectopic pregnancy has greatly increased.Various medical treatment methods are also increasingly used in clinical practice,but there is no large-scale,systematic,and comprehensive clinical research to evaluate efficacy.This article reviews the clinical data of four different dosing regimens based on MTX for the treatment of patients with ectopic pregnancy,comprehensive analysis of the clinical efficacy of treatment,preliminary discussion of the clinical efficacy of better,fewer side effects for ectopic pregnancy medical treatment to provide experience and valuable clinical reference.MethodFrom January 2016 to January 2018,a retrospective analysis was performed on 314cases of gynecological patients admitted to the Second Affiliated Hospital of Guangzhou Medical University who were received medical treated because of“ectopic pregnancy”.According to different dosing regimens,they were divided into 4 groups,group A(MTX50 mg 1^st、7th day intramuscular injection once),64 cases;group B（MTX50 mg1st、7th day intramuscular injection once+mifepristone）,92 cases:Group C（MTX 20 mg intramuscularly qdx5 days）,74 cases;Group D（MTX 20 mg intramuscularly,qdx5days+mifepristone）,85 cases.The clinical efficacy was evaluated by changes in the patient’s bloodβ-HCG,changes in the size of the adnexal mass,clinical outcomes,and the occurrence of side effects.Result1.The effects of different dosing regimen on the patient’sβ-hCG.（1）The change trend ofβ-hCG in patients with different dosing regimens:In the patients of group A,B,C,and D,β-hCG transiently increased within 1 week after treatment with different dosing regimens.（2）The time required forβ-hCG to decrease by≥75%after treatment with different dosing regimens:The time required for?-hCG to decrease by≥75%in the four groups was statistically significant（P<0.05）.The time required for the decrease ofβ-hCG ≥75%in group B was the shortest,which was statistically significant compare withgroup A,C and D（P<0.05）.（3）The decrease ofβ-hCG after 2 weeks of different dosing regimens:The decline of β-hCG in the four groups after two weeks of treatment was statistically significant（P<0.05）.The decrease ofβ-hCG after 2 weeks in group B was the greatest,which was statistically significant compare with group A,C and D（P<0.05）.2.Changes in the adnexal mass of patients treated with different dosing regimens.There was no significant difference in the size of the mass between the four groups before treatment and one week after treatment（P>0.05）.However,the size of the mass in the four groups after 2 weeks of treatment was statistically significant compared with that before the treatment（P<0.05）,of which group B and D were significantly reduced in the adnexal mass after 2 weeks of treatment（P<0.01）,there was no significant difference between groups B and D（P>0.05）.3.Comparison of clinical outcomes with different dosing regimens.The clinical cure rates of the four treatment programs were compared:group A was 81.2%,group B was 85.9%,group C was 82.3%,group D was 84.7%,with no statistical significance（P>0.05）.4.The occurrence of adverse reactions with different dosing regimens.All kinds of adverse reactions in the four groups of patients,including gastrointestinal reactions,abnormal aminotransferases,oral ulcers,rashes,and myelosuppression,were not statistically significant（P>0.05）.Conclusion1.The four programs in this article to treat patients with B program to reduceβ-hCG≥5%of the time required for the shortest,2 weeks after the treatment ofβ-hCG decreased the greatest.2.There is no significant change in the early stage of the appendage area in patients with ectopic pregnancy during the four regimens,which may not be considered as an indicator of early clinical efficacy.After 2 weeks of treatment,the adnexal mass was reduced compared with that treatment before,and the adnexal mass after treatment in groups B and D was reduced more significantly.3.There was no significant difference in the clinical cure rate of ectopic pregnancy treated with the four regimens,but the attachment mass in the mifepristone group was more significantly reduced,and patients treated with mifepristone did not significantly increase adverse reactions.