The application of methotrexate combined with mifepristone in improving endocrine function and second pregnancy outcome in patients with ectopic pregnancy and fertility requirements

CAO Yuanxiu

doi:10.3969/j.issn.1002-7386.2018.07.008

Abstract：Objective To investigate the effects of methotrexate combined with mifepristone in improving endocrine function and second pregnancy outcome in patients with ectopic pregnancy and fertility requirements.Methods Two hundred patients with ectopic pregnancy and fertility requirements who were diagnosed and treated in our hospital from September 2013 to September 2016 were enrolled in the study. According to random digital table,these patients were divided into combination treatment group and single drug treatment group,with 100 patients in each group.The patients in single drug treatment group were given methotrexate 1mg/kg by intramuscular injection,however,the patients in combination treatment group,on the basis of single drug treatment group,were given orally mifepristone 25mg. Moreover combination treatment group was redivided multiple medication group (n = 50) and single medication group (n = 50) according to the medictation method of amethopterin. The medication in single medication group was the same as that in single drug treatment group,however,the patients in multiple medication group were given methotrexate 1mg/kg by intramuscular injection for three times at an interval of 2 hours.Then the serum levels of villi gonadotropin(beta HCG) were detected by radio-immunity assay,with 2-year follow up,and the curative effects and incidence rate of adverse reactions were statistically analyzed.Moreover the serum levels of HCG ) and bag piece diameter before treatment and on 7d,14d after treatment as well as the status of secondary pregnancy outcome on 6m,12m,18m,24m after treatment were observed and compared among groups.Results The effective rate in multiple medication group and single medication group was significantly higher than that in single drug treatment group (P<0.05), however there was no significant difference between multiple medication group and single medication group (P >0.05). The serum levels of beta HCG on 7d,14d after treatment and time of recovering to normal state in multiple medication group and single medication group were significantly lower than those in single durg treatment group (P<0.05),but there were no significant differences between multiple medication group and single medication group (P>0.05). In addition the bag piece diameter and disappearing time on 7d,14d after treatment in multiple medication group and single medication group were significantly less than those in single drug treatment group (P<0.05),however there were no significant differences between multiple medication group and single medication group(P>0.05).Besides the incidence rate of adverse reactions in multiple medication group was significantly lower than that in single medication group and single drug treatment group (P<0.05),however there was no significant difference between single medication group and single drug treatment group (P >0.05).Moreover the secondary pregnancy rates on 6m,12m,18m after treatment in multiple medication group and single medication group were significantly higher than those in single drug treatment group (P <0.05),however there were no significant differences between multiple medication group and single medication group (P > 0. 05). Conclusion The methotrexate combined with mifepristone can effectively improve the therapeutic effects on ectopic pregnancy with fertility requirements,which can effectively improve the endocrine function of patients and secondary pregnancy outcome,in which, methotrexate multiple dedication scheme has better security and has no adverse effects on clinical curative effects and secondary pregnancy outcome,therefor,which is worth using widely in clinical practice.