Abstract Objective To assess the therapeutic effect of single dose methotrexate (
MTX) combined with Chinese medicinal herbs on
ectopic pregnancy (EP). Methods Eighty five
patients with EP were prospectively
treated with an intramuscular injection of MTX (50 mg/m 2), without citrovorum factor rescue, to destroy the embryo and villi. Meanwhile, Chinese medicinal herb, Ectopic Pregnancy Prescription 1 (EP1, Radix salviae miltiorrhizae 15 g, Radix paeoniae rubra 15 g, and Semen persicae 9 g) decoction was given orally to patients with early rupture or tubal abortion and without shock, and Ectopic Pregnancy Prescription 2 (EP2, Radix salviae miltiorrhizae 15 g, Radix paeoniae rubra 15 g, Semen persicae 9 g, Rhizoma spaarganii 6 g, and Rhizoma zedoariae 6 g) decoction to patients without rupture or with late rupture with formation of hematomas in the abdominal or pelvic cavities. Serum β subunits of human chorionic gonadotropin (hCG) were monitored regularly until they were undetectable. Gestational sac, fetal cardiac activity, EP mass absorption, etc., were observed by serial ultrasound. For patients attempting pregnancy, hysterosalpingogram was given after EP mass totally disappeared. Results One dose of MTX together with EP1 or EP2 decoction successfully treated all patients with hCG β
subunit concentration ≤20 μg/L, but failed in all patients with hCG β subunit concentration≥ 40 μg/L and/or emerging fetal cardiac activity. Eighty one (95.3%) patients were successfully treated without surgery, and 4 (4.7%) required surgical treatment. Mean clearance time for serum hCG β subunit was 18.7±7.2 (range 10 59) days, and time required for total disappearance of EP mass as assessed by transvaginal sonography was 1.2±0.7 (range 0.5 5.5) months. Hysterosalpingograms in 20 patients attempting pregnancy demonstrated tubal patency on the involved side in 90.0% (18 patients). After 6 months to 1 year of follow up for the 20 patients, 15 intrauterine pregnancies were achieved, but 1 patient suffered from recurrent EP. Conclusions Combination of traditional Chinese medicine and western medicine may enlarge the scope of EP treated with MTX only, with good therapeutic efficacy. However, patients with serum hCG β subunit≥20 μg/L before treatment may require additional injection of MTX to obtain the expected decrease in hCG β subunit titer.
More abstracts about the Combination of single-dose methotrexate and Chinese medicinal herbs for treating ectopic pregnancy