ANALYSIS OF THE RESULTS OF CONSERVATIVE MANAGEMENT OF ECTOPIC PREGNANCY USING METHOTREXATE

Abstract

Today, ectopic pregnancy remains a common gynecological emergency around the world and is defined as the implantation of a fertilized egg outside the uterine cavity. The fallopian tube is the most common site of attachment of the fertilized egg, and tubal pregnancies account for 95.5% of all cases of ectopic pregnancy. Taking into account modern practice, two methods of treating tubal pregnancy can be noted – conservative with the use of methotrexate and surgical. And although conservative management of this pathology is 70–90% effective and safe, in Ukraine the frequency of use of this drug does not exceed 15%. The presented article highlights modern recommendations for the use of methotrexate for the treatment of tubal pregnancy and directly analyzes the results of conservative management of women with undisturbed tubal pregnancy in the department of planned minimally invasive and plastic gynecology of subdivision № 3 of the KNP “City Clinical Hospital № 6”. The aim of the study. The purpose of the study is to analyze the results and determine the features of managing patients with intact tubal pregnancy using methotrexate. Materials and methods. We analyzed 49 cases of treatment of tubal pregnancy with methotrexate in hemodynamically stable patients of the department of planned minimally invasive and plastic gynecology of subdivision № 3 of the KNP “City Clinical Hospital № 6” for 2020–2022. A systematic online study of articles on the use of methotrexate was conducted. Results and discussion. Drug treatment of tubal pregnancy with methotrexate was used in 49 women (31.4%) out of 156 who were hospitalized with a diagnosis of ectopic pregnancy. All patients met the established requirements for conservative management of ectopic pregnancy. The average age of women in the study group was 22.3 ± 3.5 years. In the obstetric history, the first pregnancy was identified in 31 patients (63.3%), repeated pregnancy – in 18 patients (36.7%). In women with repeated pregnancies, physiological births accounted for 66.7% (12 cases), cesarean sections – 33.3% (6 cases). Two or more births were detected in 4 patients (22.2%). Abortions occurred in 10 women with repeat pregnancies (55.6%). Primary infertility was detected in 9 women (18.4%), secondary infertility – in 1 woman (2.0%). Regular menstrual cycle disorders of various types were observed in 17 patients (34.7%). 5 women (10.2%) had chronic inflammatory processes of the pelvic organs. Combined oral contraceptives were used as a method of contraception by 1 woman (2%). Preliminary surgical interventions on the pelvic organs were performed in 11 women (22.4%) with conservative management of tubal pregnancy. Of these, the indications for surgical intervention were: genital endometriosis – in 2 patients (18.2%), ectopic pregnancy – in 5 patients (45.5%), tubo-peritoneal factor of infertility – in 4 patients (36.3%). In 2 patients (40%) with a previously operated tubal pregnancy, the fallopian tube was preserved. In 1 patient (50%), this ectopic pregnancy was diagnosed in a preserved fallopian tube. 7 patients (14.3%) had chronic diseases of the urinary system. A single injection of the drug at a rate of 50 mg/m2 of body surface was performed in 41 women (83.7%), repeated administration was used in 8 women (16.3%). Surgical treatment with progression of tubal pregnancy was performed in 7 women (14.3%). Conclusions. The use of methotrexate during conservative therapy for tubal pregnancy in the department of planned minimally invasive and plastic gynecology of subdivision № 3 of the KNP “City Clinical Hospital № 6” allowed to avoid surgical intervention and preserve reproductive function and health in 85.7% of women.