[Non-surgical therapy of ectopic pregnancy]

The most common type ectopic pregnancy is that which occurs in the tube. The latter occupies 98% of the former. Patients with tubal pregnancy have been operated immediately after the establishment of diagnoses. However, tubectomy sometimes causes to a variety of complications. Subsequent fertility is also much impaired because of damage to the uninvolved tube and tubectomy results in the absolute sterility in cases with the obstruction of the other tube. Thus, non-surgical treatment for the patients should be expected in order to avoid such problems. In the present study, 9 cases of tubal pregnancy in the pre-abortional stage were detected with B-scope examination. The administration of MTX (total doses; 60-300 mg) provided the complete remission in 8 cases; the other received the tubectomy by the reason of the progression of abortion. The dose of MTX used to obtain the remission is responsible for the HCG titer of urine before the treatment; 60-105 mg of MTX was sufficient in cases which showed the titer below 1,000 iu/l, though 75-300 mg was necessary in cases over 4,000 iu/l. Patency of tubes after the regimen was confirmed in 5 out of 6 cases with hystero-salpingography. Serious side effects have not been observed in the present study in spite of the great efficacy; transient suppression of liver and bone marrow function has been observed in 3 cases. Two patients had normal intra-uterine pregnancy subsequent to the treatment; one had a matured full-term female neonate and the other received D&C on 9 gestational weeks. These results suggest that the MTX regimen is practical for the treatment of patients with tubal pregnancy. This is characterized by unimpaired fertility following the treatment, although detection of patients in the pre-abortional stage is absolutely necessary.