Managing Ectopic Pregnancies by Targeting Chorionic Villi with a Transvaginal Injection of Ethanol into the Lacunar Space

Biomedicines

Masaji Nagaishi¹  Makio Shozu²  Keiichi Kato³  Hirotsune Kaijima⁴  Hisao Osada⁵  Shokichi Teramoto⁵  Tomoya Segawa⁶ 

[1] Department of Obstetrics and Gynecology, School of Medicine, Nihon University, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan;Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba Prefecture, Chiba 260-0876, Japan;Kato Ladies Clinic, Westgate Shinjuku Building, 7-20-3, Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan;Minatomirai Yume Clinic, 2F MM Park Building, 3-6-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa 220-0012, Japan;Natural ART Clinic Nihombashi, 8F Tokyo Nihombashi Tower, 2-7-1 Nihombashi, Chuo-ku, Tokyo 103-6008, Japan;Shimbashi Yume Clinic, EXCEL Shimbashi, 2-5-1, Shimbashi, Minato-ku, Tokyo 105-0004, Japan;

关键词: chorionic villi-targeted therapy;    ectopic pregnancies;    absolute ethanol;    nonsurgical management;    transvaginal ultrasonography;    methotrexate;   

DOI  :  10.3390/biomedicines8070202

来源: DOAJ

【 摘 要 】

Methotrexate has been the main mode of non-surgical treatment for ectopic pregnancies. However, we have developed an easier, repeatable method that can be applied even to patients with a high beta-human chorionic gonadotropin (β-hCG) level and/or positive fetal heartbeat, by targeting chorionic villi with a transvaginal injection of absolute ethanol (AE) into the lacunar space (intervillous space). The efficacy and safety of this method were examined in 242 cases of ectopic pregnancy, including 103 with positive fetal heartbeat. Serum β-hCG level was measured at frequent intervals, and transvaginal ultrasonography was performed to observe the gestational sac and hyperechoic inner ring. Of the 242 patients, 222 (91.7%) were successfully treated. The average number of AE injection(s) required was 1.6 (range: 1–5), and the average dose was 3.2 mL. After the treatment, many of the patients tried to conceive again, and 63 of the traceable 145 patients (43.4%), who had fallopian tube pregnancy, and 7 of the traceable 12 patients (58.3%), who had cervical or cesarean scar pregnancies, successfully conceived and delivered babies with no observed side effects. Therefore, this method could be an effective treatment for ectopic pregnancy with the potential to replace conventional surgical interventions and medical treatment using methotrexate.

【 授权许可】

Unknown