Treatment of tubal pregnancy using comprehensive interventional methods

Abstract

Objective: To investigate the efficacy of combined interventional methods in treatment of tubal pregnancy. Materials and Methods: One hundred sixty-two patients with tubal pregnancy were enrolled in this study. In all patients, the feeding uterine artery at affected side was perfused with methotrexate (MTX), followed by occlusion using gelatin sponge. Nineteen patients were also treated by perfusion of MTX in ovarian artery at affected side which partially participated in blood supply. Seven patients received direct puncture perfusion of MTX under B ultrasound guidance. Four cases received perfusion of MTX through fallopian tube. After surgery, the serum beta-human chorionic gonadotropin (β-HCG) level was regularly detected, and B ultrasound was used to monitor the pelvic mass change. For 33 patients with fertility requirement, hysterosalpingography (HSG) was conducted after menstruation restoration. Results: Tubal pregnancy was terminated in 160 patients (98.76%), with inefficacy in two patients (1.23%) who were treated by surgery. HSG showed tubal patency in 27 patients. Tubal obstruction was found in the other six patients. After recanalization, three cases were unobstructed, with obstruction in other three cases. Fifteen patients achieved intrauterine pregnancy after six to 17 months from surgery. Conclusions: Comprehensive interventional treatment can prevent internal bleeding caused by failure of many conservative treatments, improve the indication and success rate of treatment, and preserve the complete fallopian tube.