Ectopic pregnancy: Medical treatment

The article was professionally consulted by Doctor Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.

An ectopic pregnancy is defined as a condition in which a woman's egg implants and develops outside the endometrium, causing the fetus to develop abnormally. The locations where eggs often implant in ectopic pregnancy are the fallopian tubes, ovaries, abdominal cavity, cervix, uterine wall incision... In which, clinically, ectopic pregnancy often starts The most common in the fallopian tubes, the most dangerous is the connection between the fallopian tubes and the uterus, called the interstitial pregnancy, which will cause abortion in the early stages, causing the mother to bleed a lot and quickly, and at the same time. There will also be a risk of fetal death after handling this case.
Other cases may occur in the remaining sites, some may appear bilateral ectopic pregnancy or multiple pregnancies with one pregnancy appearing in the uterus, the other two being outside the uterus. supply but very rare. Most cases of ectopic pregnancy will develop in a sequence of stages, first there will be a miscarriage, then there will be a spontaneous regression, also known as a spontaneous ectopic pregnancy. , and if it is more severe, it will rupture the fallopian tube, causing abdominal bleeding, which is very dangerous to the life of the pregnant woman and requires emergency surgery.

Some risk factors for ectopic pregnancy are:
Have a history of previous ectopic pregnancy Patients have a history of surgery on the fallopian tubes and pelvic sites Patient have pelvic inflammatory disease Sexually transmitted diseases Tobacco use Pregnant women older than 35 years Those who have had an abortion Some methods of assisted childbirth Some studies have shown found that the rate of ectopic pregnancy today is gradually increasing because of abortions taking place more often as well as patients with sexually transmitted diseases. Therefore, when there are any symptoms that make a patient suspect an ectopic pregnancy, it is necessary to consult a doctor as soon as possible for advice on how to handle the most appropriate ectopic pregnancy.
Signs of an ectopic pregnancy that a pregnant woman should not ignore are missed periods, breast tenderness, abnormal abdominal pain, abnormal vaginal bleeding. In particular, when the patient has symptoms of sudden, severe abdominal pain or perhaps shoulder pain accompanied by dizziness and fainting, the possibility of fetal rupture is very high, so in these cases it is necessary to seek medical attention immediately for diagnosis and treatment.

The methods of treatment for ectopic pregnancy that are applied today include:
Medical treatment Surgery Monitoring ectopic pregnancy that resolves itself Surgery performed in ectopic pregnancy is an open laparotomy technique to cut the fallopian tubes or open the fallopian tubes and remove the pregnancy mass, then stop bleeding for the mother and preserve the fallopian tubes so that the woman can continue to give birth in the next time. In addition, laparoscopic ectopic pregnancy is the most modern method today, allowing the incision to heal faster and less invasive to the patient's body, but this method is only effective when the patient has an ectopic pregnancy. Uterus to see the doctor as soon as possible, if the pregnancy mass has ruptured, it will cause abdominal bleeding, so it is difficult to have laparoscopic surgery
Medical treatment is also an effective way to handle ectopic pregnancy. Drugs used for medical treatment of ectopic pregnancy are Methotrexate, RU486, Prostaglandine, Potassium Chloride..., of which the most popular and effective is still Methotrexate. Methotrexate's mechanism of action on pregnant women is to block the activity of the enzyme that converts inactive folic acid into active folic acid which is a component of amino acids, from which Methotrexate will indirectly prevent the breakdown of folic acid. DNA division, as a result, cells cannot multiply and develop, so the ectopic pregnancy mass will be absorbed into the body after taking the drug for about 4 to 6 weeks. A special feature of this method is that the woman's fallopian tube is still kept to facilitate the next pregnancy of the woman.

When appointing Methotrexate, there will be 2 regimens selected by the doctor depending on the Beta hCG concentration in the woman's body before taking the drug, including single-dose regimen and multi-dose regimen. Patients will be treated and monitored for Beta hCG levels, if this concentration is negative after treatment, it will be effective. In some cases, Beta hCG levels can increase and decrease after taking the drug, the patient will be adjusted Methotrexate dose and can apply surgery if necessary.
Some side effects when using Methotrexate that patients need to be aware of are:
Nausea or vomiting, which may be accompanied by epigastric abdominal pain is a sign of gastritis. Tired body, often anorexia. Diarrhea Symptoms of mouth sores appear Changed vision Loss of hair More sensitive to sunlight. Myelosuppression, bone marrow suppression leads to leukopenia in the blood, so the patient will have a reduced level of resistance to some diseases. Liver failure Renal failure Ectopic pregnancy is a common disease during pregnancy, which can endanger the life of the mother. The way to handle ectopic pregnancy when the patient comes early and timely, when the pregnancy has not broken is medical treatment. This is an effective method, preventing the growth of ectopic pregnancy while preserving the fallopian tubes. However, in more severe cases and the pregnancy has ruptured, the most commonly used treatment for ectopic pregnancy is surgery.
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