{"title":"辅助生殖技术后使用多次大剂量甲氨蝶呤成功治疗宫颈和输卵管残端双妊娠:病例报告。","authors":"Andrey Gaiday, Akylbek Tussupkaliyev, Abay Nurken, Assel Gaiday, Ainur Primbetova, Moldir Dossimbetova, Assemgul Yeszhanova, Bibigul Karimsakova, Nurgul Ablakimova","doi":"10.30476/IJMS.2024.102119.3487","DOIUrl":null,"url":null,"abstract":"<p><p>The incidence of ectopic pregnancy (EP) has increased in recent years, owing to causes such as pelvic inflammatory diseases and assisted reproductive technologies (ART). The present study reported a case of a 33-year-old nulliparous woman with a history of previous ectopic pregnancies, who underwent pelvic ultrasound in August 2022, which revealed a double EP including a cervical pregnancy and a tubal stump pregnancy. Despite known risk factors and elevated beta-human chorionic gonadotropin (β-hCG) levels, a conservative approach, utilizing multiple doses of systemic methotrexate (MTX) injections, was employed to preserve fertility at the Regional Perinatal Center in Aktobe, Kazakhstan. Treatment efficacy was monitored through β-hCG levels and ultrasound imaging, with successful resolution of both EPs and preservation of reproductive function. The present case highlighted the safety and efficacy of MTX therapy in managing complex EP presentations, emphasizing the necessity of individualized treatment approaches in reproductive medicine, particularly in terms of preserving fertility in patients undergoing ART. Multiple high doses of MTX injections were beneficial for pregnancy with two distinct regions, fetal cardiac activity, and elevated serum β-hCG level. Further research is required to explore optimal treatment strategies for EP, considering patient-specific factors and treatment goals.</p>","PeriodicalId":14510,"journal":{"name":"Iranian Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300944/pdf/","citationCount":"0","resultStr":"{\"title\":\"Successful Management of Cervical and Tubal Stump Double Pregnancy after Assisted Reproductive Technologies Using Multiple High Doses of Methotrexate: A Case Report.\",\"authors\":\"Andrey Gaiday, Akylbek Tussupkaliyev, Abay Nurken, Assel Gaiday, Ainur Primbetova, Moldir Dossimbetova, Assemgul Yeszhanova, Bibigul Karimsakova, Nurgul Ablakimova\",\"doi\":\"10.30476/IJMS.2024.102119.3487\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>The incidence of ectopic pregnancy (EP) has increased in recent years, owing to causes such as pelvic inflammatory diseases and assisted reproductive technologies (ART). The present study reported a case of a 33-year-old nulliparous woman with a history of previous ectopic pregnancies, who underwent pelvic ultrasound in August 2022, which revealed a double EP including a cervical pregnancy and a tubal stump pregnancy. Despite known risk factors and elevated beta-human chorionic gonadotropin (β-hCG) levels, a conservative approach, utilizing multiple doses of systemic methotrexate (MTX) injections, was employed to preserve fertility at the Regional Perinatal Center in Aktobe, Kazakhstan. Treatment efficacy was monitored through β-hCG levels and ultrasound imaging, with successful resolution of both EPs and preservation of reproductive function. The present case highlighted the safety and efficacy of MTX therapy in managing complex EP presentations, emphasizing the necessity of individualized treatment approaches in reproductive medicine, particularly in terms of preserving fertility in patients undergoing ART. Multiple high doses of MTX injections were beneficial for pregnancy with two distinct regions, fetal cardiac activity, and elevated serum β-hCG level. 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引用次数: 0
摘要
近年来,由于盆腔炎和辅助生殖技术(ART)等原因,异位妊娠(EP)的发病率有所上升。本研究报告了一例曾有过宫外孕病史的 33 岁女患者,她于 2022 年 8 月接受了盆腔超声检查,结果显示她患有双宫外孕,包括宫颈妊娠和输卵管残端妊娠。尽管存在已知的风险因素和β-人绒毛膜促性腺激素(β-hCG)水平升高,但哈萨克斯坦阿克托别地区围产中心仍采用了保守治疗方法,即全身注射多个剂量的甲氨蝶呤(MTX),以保留生育能力。通过β-hCG水平和超声成像监测治疗效果,成功解决了两个EP,并保留了生殖功能。本病例凸显了MTX疗法在治疗复杂EP表现方面的安全性和有效性,强调了生殖医学中个体化治疗方法的必要性,尤其是在保留接受抗逆转录病毒疗法患者的生育能力方面。多次大剂量注射MTX有利于两个不同区域的妊娠、胎儿心脏活动和血清β-hCG水平升高。考虑到患者的具体因素和治疗目标,还需要进一步研究探索 EP 的最佳治疗策略。
Successful Management of Cervical and Tubal Stump Double Pregnancy after Assisted Reproductive Technologies Using Multiple High Doses of Methotrexate: A Case Report.
The incidence of ectopic pregnancy (EP) has increased in recent years, owing to causes such as pelvic inflammatory diseases and assisted reproductive technologies (ART). The present study reported a case of a 33-year-old nulliparous woman with a history of previous ectopic pregnancies, who underwent pelvic ultrasound in August 2022, which revealed a double EP including a cervical pregnancy and a tubal stump pregnancy. Despite known risk factors and elevated beta-human chorionic gonadotropin (β-hCG) levels, a conservative approach, utilizing multiple doses of systemic methotrexate (MTX) injections, was employed to preserve fertility at the Regional Perinatal Center in Aktobe, Kazakhstan. Treatment efficacy was monitored through β-hCG levels and ultrasound imaging, with successful resolution of both EPs and preservation of reproductive function. The present case highlighted the safety and efficacy of MTX therapy in managing complex EP presentations, emphasizing the necessity of individualized treatment approaches in reproductive medicine, particularly in terms of preserving fertility in patients undergoing ART. Multiple high doses of MTX injections were beneficial for pregnancy with two distinct regions, fetal cardiac activity, and elevated serum β-hCG level. Further research is required to explore optimal treatment strategies for EP, considering patient-specific factors and treatment goals.
期刊介绍:
The Iranian Journal of Medical Sciences (IJMS) is an international quarterly biomedical publication, which is sponsored by Shiraz University of Medical Sciences. The IJMS intends to provide a scientific medium of communication for researchers throughout the globe. The journal welcomes original clinical articles as well as clinically oriented basic science research experiences on prevalent diseases in the region and analysis of various regional problems.