How to treat ectopic pregnancy conservatively with drugs

  Ectopic pregnancy, also known as ectopic pregnancy, refers to the implantation of a fertilized egg in any part of the body other than the uterine cavity and is one of the common emergencies in obstetrics and gynecology and one of the main causes of maternal mortality. In recent years, the incidence of ectopic pregnancy has been on the rise, accounting for 0.3%-1.0% of all pregnant women. As a common gynecologic emergency, ectopic pregnancy has been gaining widespread attention from clinicians.  Non-surgical treatment: including expectant therapy, chemotherapy, Chinese herbal medicine and interventional therapy, should be carefully selected according to the condition.  1. Expectant therapy: no clinical symptoms or mild clinical symptoms; ectopic pregnancy mass <3cm in diameter, no fetal heartbeat, no intra-abdominal bleeding or estimated internal bleeding less than 100ml; blood β-hCG <1000mIU/ml and continues to decline. Patients can be instructed to rest at home and come to the hospital for weekly rechecking of blood β-hCG, and to consult the doctor anytime during the period when abdominal pain worsens.  2. Chemotherapy: Patients with fertility requirements, especially those whose contralateral fallopian tubes have been removed or have obvious lesions. It is suitable for patients with no obvious abdominal pain, maximum mass diameter 3.5-5.0cm, β-hCG <2000~3000mIU/ml, stable vital signs, no signs of active intra-abdominal bleeding and normal liver function and blood picture. The commonly used drug is methotrexate 50mg/m2, injected intramuscularly, and if the blood β-hCG decreases less than 15% in 4-7 days after administration, the drug can be repeated. Blood β-hCG decreases to normal in 35 days on average, and attention is paid to monitoring blood routine and ultrasound. In recent years, some scholars have used mifepristone for the conservative treatment of ectopic pregnancy, which is still inconclusive.  3.Chinese herbal medicine treatment: It is one of the current treatment methods for tubal pregnancy in China, which eliminates the trauma of surgery, preserves the affected fallopian tube and restores its function. The main formula is Salvia miltiorrhiza, Radix et Rhizoma Paeoniae, Peach kernel, with addition and subtraction according to the evidence.  4. Interventional therapy: After angiography, slow injection of 50-100mg of methotrexate into the uterine artery, plus 500mg of 5-Fu for large gestational sacs, and embolization of the uterine artery with absorbable gelatin sponge particles after the infusion. After embolization, the patient's vital signs are closely monitored and blood β-hCG and ultrasound are rechecked weekly.