title: Clinical effectiveness of multiple-drug injection treatment in unruptured ectopic pregnancies: a retrospective study.
abstract: OBJECTIVE
  To study the effect of local interventional treatment of unruptured ectopic pregnancies with multiple-drug injection guided by color Doppler sonography.
  
  
  METHODS
  In this retrospective analysis, 49 patients with an unruptured ectopic pregnancy were treated with two different local injection methods administered under sonographic guidance. The patients were divided into single-drug (n = 23) and multiple-drug (n = 26) injection groups, and they received a locally administered injection of methotrexate alone or a combination including methotrexate, hemocoagulase, antibiotics, and anti-inflammatory drugs, respectively. Overall, local injection treatment was successful in 44 patients. The 5 patients with failed treatment underwent laparotomy about 1 week after single-drug injection. Serum β-human chorionic gonadotropin (β-hCG ) levels, ectopic pregnancy mass sizes, blood flow at various points after treatment, the incidence of pelvic bleeding, and the time for serum β-hCG levels to return to normal and the mass to resolve were analyzed in the remaining 44 patients.
  
  
  RESULTS
  Single-drug treatment was successful in 18 patients; 10 of 23 had low to moderate pelvic bleeding after treatment, and 5 were referred for surgery. All 26 patients were successfully treated by multiple-drug injection. Only 2 patients had a small amount of pelvic bleeding. Differences between groups were statistically significant (P < .05) for surgery rates, the incidence of pelvic bleeding, transient increases in serum β-hCG levels, mean days to normal β-hCG levels, mean days of mass resolution, and mean mass diameters 1 to 6 weeks after treatment.
  
  
  CONCLUSIONS
  Local multiple-drug injection under color Doppler guidance is a new, safe, and effective method for treating unruptured ectopic pregnancies. It accelerates the serum β-hCG decline and facilitates mass resolution. This regimen is associated with a very low rate of pelvic bleeding, improves the success rate of conservative treatment, and, therefore, has value as an important clinical application.
authors.affiliation: Department of Ultrasonography, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan St, 150001 Harbin, Heilongjiang Province, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Dai
authors.forename: Lu-Lu
authors.initials: LL
authors.lastname: Wang
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Shao
authors.forename: Si-Ming
authors.initials: SM
authors.lastname: Wang
authors.forename: Xiao-Qiu
authors.initials: XQ
authors.lastname: Dong
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000517:prevention & control; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging / Q000188:drug therapy; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D004338:Drug Combinations; D008727:Methotrexate