الفهرس 
Chapter (1) : Pathogenesis of Ectopic PregnancyOnly 14 pages are availabe for public view
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Abstract
Ectopic pregnancy is a common, life-threatening condition affecting 1 in 100 pregnancies. It occurs when the fertilized egg
implants outside the cavity of the uterus. Most ectopic pregnancies
develop in the fallopian tube. Management of ectopic pregnancy remains traditionally
surgical. Early detection of unruptured ectopic pregnancies, using both
ultrasound techniques and B-human chorionic gonadotropin (B-hCG)
assays, allows a more conservative treatment with methotrexate which
considered the treatment of choice over surgical intervention,
especially in patients who are hemodynamically stable. Methotrexate is a powerful drug which works by interfering, in a
temporary way, with the processing folate which helps rapidly
dividing cells – such as those of a pregnancy. The drug stops the
pregnancy developing so it gradually reabsorbed. The aim of this study was to compare, in a randomized study,
between the efficacies of two methods of administering methotrexate
in the treatment of early ectopic pregnancy: single dose IM injection
and multiple doses IM injections regimens. This study was carried out on 40 patients admitted to the
obstetrics & gynecology department at Menofiya university
hospital and diagnosed as undisturbed ectopic pregnancy. They were
included in the study based on inclusion criteria including (age ≥ 19 years, with positive pregnancy test, suggestive clinical picture of EP
with confirmed diagnosis via TVS which show no evidence of
intrauterine gestational sac (GS) with or without adnexal mass and no
fluid collection at Douglas pouch, hemodynamic stability, ability of
the patient to comply with post-treatment monitoring, absence of
history of allergy, sensitivity or contraindication to methotrexate and
pretreatment serum B-hCG concentration less than 5000 IU/L. During the present study, the administration of MTX was given
either single dose IMI (group A, n=20), or multiple doses IMI (group
B, n=20), methotrexate was injected in a dose of 1mg/kg. The overall success rate, defined by a normal post-treatment BhCG
level (<5 mIU/mL) was 92.5% (n=37) in total studied cases. It
was 90% (n=18) in single dose group and 95% (n=19) in multiple
doses group. These results indicate that multiple doses regimen had
higher success rate than single dose regimen in treatment of early
undisturbed ectopic pregnancy. In total, there were three failures of medical treatment (7.5%):
two in group A (single dose regimen) (5%) and one in group B
(multiple doses regimen) (2.5). Surgical interference (laparotomy) had
been indicated for failed patients. Main risk factors for EP including history of IUDs use, past PID
and previous ectopic pregnancy were evaluated during the course of
the study and they were statistically significant. During this study, the most common side effect during the
course of treatment was the gastric upset while the statistically
significant difference was vomiting, pelvic pain, only one case in
group B had developed oral ulcers and there were no cases of hair
loss.