비파열 자궁외임신에 대한 Methotrexate 의 전신적 및 국소적 요법에 대한 임상연구 = A Clinical Study of Unruptured Ectopic Pregnancies with the Treatment of Systemic or Local Methotrexate Injecton

다국어 초록 (Multilingual Abstract)

Objective : To evaluate safety and efficacy of systemic or local methotrexate(MTX) injection to patients with unruptured ectopic pregnancy Methods : From October 1995 to October 1999, 35 unruptured ectopic pregnancies were eligible for the conservative management. 25 tubal pregnancies, 4 cervical pregnancies, 4 pregnancies of previous cesarean section scar, and 2 cornual pregnancies diagnosed by ultrasonography & serumβ-hCG were evaluated. Patients were treated with one of following three protocols : ① A single-dose of 50mg/m2 of intramuscullar(IM) MTX(7 cases) ② Two to four doses of 1.0mg/kg of IM MTX with citrovorum rescue(20 cases) ③ Transvaginal ultrasonogram-guided intra-amniotic instillation of 50mg methotrexate (8 cases)
The mean age of these patients was 30.8 yrs (range 24-42) and gestational age at diagnosis ranged from 22-75 days (mean 47). Initial level of serumβ-hCG ranged from 166.4-55363.8 mIU/mL (mean 9069.2). Patients were monitored with serumβ-hCG titers three times per week ,and then weekly until the serumβ-hCG level was less then 10 mIU/mL. Result : 31 of 35 patients (88.6%) were successfully treated and remaining 4 patients failed conservative therapy and so required surgery. Mean duration of resolution was 38.5 days (range 11-105). Side effect rate was 45.7% but severity of symptoms were so mild that no treatment was needed in most cases. Conclusion : Nonsurgical conservative management of MTX appears to be effective and safe treatment modality for some selected unruptured ectopic pregnancy. But further comparative studies and long-term follow-up are needed to evaluate reproductive outcome and reduce side effects of MTX.