title: Combined chemotherapy in the medical management of tubal pregnancy.
abstract: The medical management of early unruptured tubal ectopic pregnancies is gaining acceptance internationally as an alternative to surgical procedures. This method has been shown to be effective and safe in properly selected cases and with adequate supervision. Most of the work however has been done using either methotrexate or prostaglandins. The present study aimed to evaluate the efficacy of a combined therapeutic regimen. The efficacy was noted to be at least as good but with fewer side-effects. The treatment was effective in 18 out of 19 cases of tubal pregnancies (94.7%). One patient complained of a gastritis which resolved with antacids. One patient experienced abdominal cramps and transient hypotension probably as a profound vagal response during tubal abortion. The median time to resolution varied directly with the initial serum beta HCG level at diagnosis. All patients who responded to the therapy described the experience as painless and viewed the treatment positively as it spared them the need for surgery and its attendant anaesthetic risks. However, we strongly recommend caution and close supervision and to keep the patient in the hospital at least for the first week of therapy.
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: C
authors.initials: C
authors.lastname: Anandakumar
authors.forename: M A
authors.initials: MA
authors.lastname: Choolani
authors.forename: P G
authors.initials: PG
authors.lastname: Adaikan
authors.forename: Y C
authors.initials: YC
authors.lastname: Wong
authors.forename: M
authors.initials: M
authors.lastname: Gopal
authors.forename: B
authors.initials: B
authors.lastname: Marshall
authors.forename: S S
authors.initials: SS
authors.lastname: Ratnam
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D015232:Dinoprostone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000964:Antimetabolites, Antineoplastic; C016767:sulprostone; D015232:Dinoprostone; D008727:Methotrexate