Medical treatment of intra-uterus pregnancy

Article written by Dr. Dang Pham Quang Thai – Obstetrician and Gynecologist, Obstetrics and Gynecology Department – Share99 Times City International Health Hub

An extra-intra-uterus pregnancy is when the embryo nests and develops outside the uterus chamber. Ruptured fisses will cause massive, life-threatening bleeding. The majority of extra-intra-uterus pregnancies are in the proboscis, in addition to which can be encountered in other places such as: Intra-abdominal pregnancy, ovarian pregnancy, pregnancy at the old cesarean section …

1.1 Treatment objectives

Tackle the intra-uterus mass to:

• Minimize the incidence of complications (bleeding rupture), med death of the mother
• Prevention of recurrence of an extra-intra-uterus pregnancy
• Maintain fertility for the mother

1.2 Methods in the treatment of analta

Currently, there are 3 methods used in the treatment of uterus:

• Drug: The most common drug used to treat uterus is Methotrexate. This drug prevents cells from growing, ends pregnancy, the proboscis is preserved.
• Open Surgery: If an extra-intra-uterus pregnancy causes a massive rupture of the bleeding proboscis in the abdomen, urgent surgery is required. Currently, due to early detection of extra-intra-uterus pregnancy, cases of abdominal opening are rare. These cases often have to combine anti-stun resuscitation due to high blood loss.
• Laparoscopic surgery: Now widely applied in the treatment of extra-intra-intra-uterus surgery
  • Endoscopy for diagnosis of uterus
  • Endoscopy preserves proboscis in cases where there is still a need for childbirth
  • Endoscopy cuts the proboscis in case there is no longer a need for birth or cannot be preserved

The choice of treatment depends on each specific case.

2.1. Single-dose Methotrexate (MTX) treatment in order

• Hemolysis is stable (without stunting).
• βhCG concentration < = 5000 mIU / ml.
• There is no embryo, the fetal heart in the intra-uterus fetal mass (via ultrasound).
• Fetal mass size < 3 – 4 cm (qua siêu âm).

2.2. Multi-dose MTX treatment in which multi-dose mtx is ins specified

• Hemolysis is stable (without stunting).
• βhCG concentration > 5,000 mIU/ml and < = 10.000 mIU / ml.
• Fetal mass size < 5 cm (qua siêu âm).
• Interstitial intra-uterus pregnancy < 3cm.

2.3. Contraindicing to medical treatment

• Hemolysis is unstable (pre-stunned, stunned): rapid pulse, HA drops, pale skin, sweating, nausea, vomiting, Hb/Hct decrease.
• Signs of rupture: abdominal pain is numerous and gradually increased, or ultrasound has an estimated volume of > 300 ml, or abdominal volume.
• There is additional coordination of pregnancy in the uterus.
• Breastfeeding.
• Allergy to MTX.
• There are medical diseases: renal failure, peptic ulcer,active lung disease, immuno impairment.
• MTX treatment is not accepted.
• Abnormal pre-chemotherapy tests (BC < 3000, Tiểu cầu < 100.000, tăng men gan SGOT, SGPT > 100UI/L, increased creatinine, blood clot factor disorders…).
• Does not meet the above treatment indicators.

2.4. Pre-treatment testing with MTX

• Blood, blood type, Rh.
• Blood glucose, Liver function, kidneys
• Total blood clots.
• Electrolysic. Straight cardimonary radiotholysis

The following symptoms may be encountered during treatment

3.1. sick

• Day 2 – Day 3 after the injection, patients may see increased abdominal pain due to a miscarriage through the speakers, or the stretching of the proboscis by hematoma in the proboscis. Pain will gradually decrease in the following days, it is possible to give analgesic drugs.
• If the pain increases, it is necessary to have a clinical examination, an ultrasound, a blood formula to re-evaluate the hemolysis to see if there is an internal hemorrhage.

An increase in fetal size is not considered a failure of medical treatment.

75% of BN will have moderate abdominal pain, which, from 1-2 days, occurs after the start of treatment 2-3 days.

3.2. βhCG

• Increased β hCG day 4 compared to the first day / common MTX treatment, which is not considered a therapeutic failure.
• Average time to β hCG < 15mUI/ml là 35 ngày, dài nhất 109 ngày.

3.3. Hematoma

• 56% of the intra-uterus has an increase in size after MTX treatment.
• Ultrasound may have an edge mass of the uterus as soon as β HCG < 5mUI/ml, và mất đi sau 3 – 6 tháng.
• An increase in fetal size is not considered a failure of medical treatment.

3.4. Prescribe surgical intervention as soon as

• Abdominal pain is numerous, hemolysis is unstable.
• Ultrasound sees the fetal mass enlarged, there is a lot of abdominal volume.
• Increase β hCG or do not decrease according to the tracking regimen.

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