Patient Question.
Disease: Ectopic pregnancy
Description of the disease: I was diagnosed and hospitalized on November 28, and was treated conservatively for two weeks, mainly with mifepristone and injections, and later with herbal medicine, and had my blood checked every three days, from 961 at the time of admission to 887.761.621.524. I have a small amount of bleeding since December 10, almost 20 days, and now there is only a small amount of discharge and no more bleeding.
Hope to provide help: decline slowly, want to know whether this situation is the choice to continue conservative or laparoscopic surgery, if conservative there is still a risk of rupture?
Treatment status: Time: 2013-11-28 to 2013-12-11.
Hospital department: gynecology.
Treatment process: taking mifepristone and mtx, hcg values are 887.761.621.524 respectively.
Medication: Name of medicine: Chinese herbal medicine for ectopic pregnancy
Dosing instructions: divided into three doses
Drug name: Mifepristone
Dosage instructions: Take four capsules twice a day for three days as a course of treatment, and then take three more days after seven days for a total of two courses of treatment
Meng Jun replied.
The probability of success is relatively high, but there is still the possibility of rupture during the conservative period. Whether or not to adhere to the comprehensive weighing, including time, financial ability and so on. It is not uncommon to see cases of 3 or 4 courses of conservative treatment.
Patient Question.
Thank you, doctor. The day before yesterday, the blood value dropped to 470 again, and the mass has become smaller after taking a course of Chinese medicine, 28*11*16.
Patient Question.
Thank you, doctor. The ultrasound I just had today showed that the mass was a little larger than last time, last time it was 28*16*11, today it is 30*17*19mm. Also the fluid in the rectal fossa of the uterus has increased compared to the last time, I wonder if it is blood ah.
Meng Jun replied.
The problem is not big, as long as HCG continues to decline, some other changes are often occurring for many reasons, and generally do not affect recovery.
Patient Question.
Hello, doctor, I insisted on another week, only eat Chinese medicine in the middle, but hcg value is still falling slowly, measured twice were 402, 320, three days apart and 307, now it has been the third week, if the fourth week is still not down to normal values means failure, the doctor let me play another shot less dose of mtx, before already played two shots, I can continue to choose I don’t want to have surgery, but I want to know the success rate is high, I don’t have any discomfort now.
Meng Jun replies.
Indeed, such cases are not uncommon, and the vast majority will be successful. As long as there is no acute abdomen such as rupture, you usually have to persevere. Take a look at the article I passed on to you to get an idea.
Patient Question.
Hello, doctor, originally operated last time, then the blood test dropped again and did not do it, but it is still slow to drop, now I have been hospitalized for a month, hcg dropped from 960 to 254, the size of the mass has not changed 30 * 14 * 26mm, the posterior range of the uterus 28 * 22 * 49mm, the anterior range of 23 * 16 * 80mm fluid, so much fluid is important, will continue to increase, the value is not high, but there will be an increase in bleeding. I don’t want to worry anymore. Can I choose laparoscopy now, or should I continue to insist on it?
Meng Jun replied.
HCG has been dropping from over 900, which in itself is a certain degree of success. The time to continue with the medication to be completely normal is usually not too long. I suggest to research with your doctor to consider continuing to take mifepristone. It is usually better to stick with conservative as long as there is no rupture active internal bleeding. And the probability of rupture is not great. As for the package fast and the size of the effusion can vary in a certain range because sometimes it is absorbed, sometimes it exudes a small amount, etc. It is not relevant.
Patient question.
I really want to give up conservative, I spend every day in worry, because the doctor said the mass may be mechanized, pelvic fluid is bleeding for a long time is easy to adhere, I want to ask several questions, one is according to your experience the amount of fluid in the front and back of my uterus is considered too much, there is a possibility of rupture abdominal bleeding, the second is the doctor said my progesterone 2.0, mifepristone has taken three courses of treatment, but now it does not help much. I am now taking Gui Zhi Wu Lin capsule and herbal medicine to promote blood circulation and remove blood stasis, do I need to continue to take mifepristone or herbal medicine to kill embryos, I do not have abdominal pain, occasionally my abdomen rises, said it is the cause of fluid accumulation.
Patient Question.
Also ask the doctor conservative treatment time more than a month, whether it will cause pelvic adhesions, resulting in infertility it, if adhesions whether or not to laparoscopic treatment it, if it is otherwise laparoscopic up.
Patient Question.
Today, the hcg value has dropped 9 points, and the blood flow signal has been seen around the mass, and the bleeding has increased.
Meng Jun replied.
Some of the conservative treatment time will be very long, and there are more factors affecting it. At present, there is also no standard, unified treatment plan. As for whether the adhesions will be heavier after conservative or surgery, there is also a lack of convincing evidence. That is, surgery is not the way to avoid adhesions either. There are many factors that influence whether surgery is intermediate to open or not, including the level of the surgeon, etc.
Usually with a 200+ HCG and continuing decline, without hemodynamic changes due to active bleeding, I would not resort to surgery.
Patient Question.
Thank you doctor, today I discussed with my doctor and decided to be discharged from the hospital for observation, taking mifepristone and herbs, today I had a puncture for pelvic fluid which is old blood, I would like to ask my doctor what is active bleeding
Meng Jun replies.
It is fresh bleeding in progress, generally a small amount can stop itself, can not stop the doctor will take measures such as surgery.
Meng Jun replied.
How is the treatment, there is no surgery, right, HCG?
Patient Question.
Thank you doctor care, in your encouragement did not surgery, December 30 hcg value 242.8, signed out of the hospital, the doctor asked to eat mifepristone a week, two capsules a day, a week later to recheck hcg 237, down quite slowly, the doctor let the Chinese medicine to finish eating and then go to recheck, if the drop is not ideal, consider another injection, because my liver function is normal, the doctor said the previous should be excreted, do not know I don’t know if I can get another shot. The bag of fast is now 25*11*20, the pelvic effusion is 41*19mm in the back and 56*20mm in the front. I have been feeling occasional back pain on the affected side recently, and my abdomen occasionally rises a bit for more than a month.
Meng Jun replied.
Generally do not need to be injected, slow and not afraid, as long as the drop is good. Sometimes suddenly and quickly drop significantly, the so-called water to the water. Now the program is fine.
Patient Question.
I really thank you, you are really the best doctor I have ever seen patience, this week will be re-examined, I want to know I have been treated for so long, is not already under control, the risk of rupture is very small, I am now most worried about rupture, in addition mifepristone has eaten a lot, continue to eat in addition to liver and kidney function, there will be other effects, there is so long clots and blood clots in the body I’m not sure if it will cause other diseases in the future.
Meng Jun replied.
The probability of rupture is getting smaller and smaller, but you do have to be careful, I have also met a case of rupture below HCG100. As long as the abdominal pain is severe, go to the hospital and it will be dealt with promptly. Mifepristone can be taken for a longer period of time. The mass will be absorbed, and whether or not it leaves adhesions and other sequelae varies from person to person and is not humanly controllable.