Non-surgical treatments for ectopic pregnancy

Non-surgical treatments for ectopic pregnancy include expectant management, drug therapy, and interventional therapy, which should be carefully selected based on the condition.

Expectant management

Patients with no clinical symptoms or mild clinical symptoms; ectopic pregnancy mass diameter <3cm, no fetal heart beat, no intra-abdominal bleeding or estimated intra-abdominal bleeding less than 100ml; blood β-human chorionic gonadotropin <1000mIU/ml and continuously decreasing. Patients should rest at home and come to the hospital for a weekly re-examination of blood β-human chorionic gonadotropin. If abdominal pain worsens during this period, they should seek medical attention at any time.

Drug therapy

Drug treatment is suitable for patients who have fertility requirements, especially those with ectopic pregnancy whose contralateral fallopian tube has been removed or with obvious lesions. It is suitable for patients with no obvious abdominal pain, a maximum diameter of a mass of 3.5~5.0cm, β-human chorionic gonadotropin <2000~3000mIU/ml, stable vital signs, no signs of active intraperitoneal bleeding, and normal liver function and blood count. The commonly used drug is methotrexate, 50mg/m2 intramuscular injection per day. 4~7 days after administration, the blood β-human chorionic gonadotropin decreases by less than 15%, and the drug can be repeated. It takes an average of 35 days for blood β-human chorionic gonadotropin to drop to normal, and pay attention to monitoring blood routine and B-ultrasound. In recent years, some scholars have used mifepristone for conservative treatment of ectopic pregnancy, but there is no conclusion yet.

Interventional therapy

After angiography, 50-100 mg of methotrexate is slowly injected into the uterine artery. If the gestational sac is large, 500 mg of 5-fluorouracil is added. After the infusion, the uterine artery is embolized with absorbable gelatin sponge particles. After the embolization, the patient's vital signs are closely observed, and blood β-hCG and ultrasound are checked weekly. Due to its high cost, it is currently only used in the treatment of some special types of ectopic pregnancy.