Clinical case of interstitial tubal pregnancy treatment with mifepristone and misoprostol

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Abstract

The article presents the experience of drug treatment of inertial tubal pregnancy. Currently, ectopic pregnancy is one of the most serious pathologies of pregnancy, leading to a decrease in the woman's reproductive health and directly threatening her life. In this clinical case, the possibility of treatment of ectopic pregnancy with mifepristone and misoprostol in a hospital of the 3rd level, with a patient's refusal of surgical treatment, has been demonstrated. At the moment, according to clinical recommendations adopted in the Russian Federation, interstitial tubal pregnancy is an indication for surgical treatment. Instructions for the use of mifepristone and misoprostol do not provide indications and treatment regimens for ectopic pregnancy. Medicamentous treatment of ectopic pregnancy is possible only with early diagnosis, in hospital settings and with the patient's voluntary consent. We have demonstrated the possibility to consider drug treatment not only as a therapy for despair, but also as an alternative to surgery leading to operative trauma of the reproductive organs, which is more extensive with the rare localization of interstitial tubal pregnancy, namely not only removal of the fallopian tube, but excision of the uterine tube trunk angle. Operative treatment of ectopic pregnancy leads to various complications that reduce the reproductive function of patients. Conservative treatment, perhaps, will help in the subsequent to avoid complications associated with surgical treatment and preserve the ability to procreate, in women with a burdened obstetric-gynecological anamnesis.

About the authors

Anna A. Malysheva

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: annataits1@rambler.ru

Gynecologist, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Viktoriya N. Abramova

St. Petersburg State Pediatric Medical University

Email: grantabramov@mail.ru

Gynecologist, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Vitaliy A. Reznik

St. Petersburg State Pediatric Medical University

Email: vitaliy-reznik@mail.ru

MD, PhD, Associate Professor, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Nikolay N. Ruhljada

St. Petersburg State Pediatric Medical University

Email: nickolasr@mail.ru

MD, PhD, Dr Med Sci, Professor, Head, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Anna N. Taits

St. Petersburg State Pediatric Medical University

Email: annataits1@rambler.ru

MD, PhD, Assistant Professor, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

References

  1. Адамян Л.В., Козаченко А.В., Кондратович Л.М. Спаечный процесс в брюшной полости: история изучения, классификация, патогенез (Обзор литературы) // Проблемы репродукции. – 2013. – № 6. – С. 7–13. [Adamyan LV, Kozachenko AV, Kondratovich LM. Peritoneal adhesions: the history of researh, classification and pathogenesis (a review). Modern reproductive technologies. 2013;(6):7-13. (In Russ.)]
  2. Айламазян Э.К. Эктопическая беременность // Гинекология от пубертата до постменопаузы: практическое руководство для врачей / Под ред. Э.К. Айламазяна – М.: Медпресс- информ, 2004. – С. 190–198. [Aylamazyan EK. Ectopic pregnancy. In: Ajlamazyan EK, editor. Gynecology from puberty to menopause: a practical guide for physicians. Moscow: Medpress- inform; 2004. p.190-198. (In Russ.)]
  3. Беженарь В.Ф., Айламазян Э.К., Байлюк Е.Н., и др. Этиология, патогенез и профилактика спайкообразования при операциях на органах малого таза // Российский вестник акушера-гинеколога. – 2011. – Т. 11. – № 2. – С. 90–101. [Bezhenar’ VF, Aylamazyan EK, Baylyuk EN, et al. The etiology, pathogenesis, and prevention of commissure formation during small pelvic surgery. Rossiiskii vestnik akushera-ginekologa. 2011;11(2):90-101. (In Russ.)]
  4. Гуриев Т.Д., Сидорорва И.С. Внематочная беременность. – М.: Практическая медицина, 2007. [Guriev TD, Sidororva IS. Ectopic pregnancy. Moscow: Prakticheskaya meditsina; 2007. (In Russ.)]
  5. Захаров И.С., Ушакова Г.А., Демьянова Т.Н., и др. Спаечная болезнь органов малого таза: современные возможности профилактики // Consilium Medicum. – 2016. – Т. 18. – № 6. – С. 71–73. [Zakharov IS, Ushakova GA, Dem’yanova TN, et al. Adhesive disease of the pelvic organs: modern prevention opportunities. Consilium Medicum. 2016;18(6):71-73. (In Russ.)]
  6. Кира Е.Ф., Беженарь В.Ф., Рухляда Н.Н. Качество жизни женщин после хирургического лечения эктопической беременности // Журнал акушерства и женских болезней. – 1999. – № 3. – С. 30–34. [Kira EF, Bezhenar’ VF, Rukhlyada NN. Quality of life after surgical treatment of ectopic pregnancy. Zhurnal akusherstva i zhenskikh boleznei. 1999;(3):30-34. (In Russ.)]
  7. Кира Е.Ф., Беженарь В.Ф., Рухляда Н.Н., и др. Оптимизация методов диагностики и лечения эктопической беременности // Журнал акушерства и женских болезней. – 1999. – № 2. – С. 39–45. [Kira EF, Bezhenar’ VF, Rukhlyada NN, et al. Optimization methods of diagnosis and treatment of ectopic pregnancy. Zhurnal akusherstva i zhenskikh boleznei. 1999;(2):39-45. (In Russ.)]
  8. Кулаков В.И., Гаспаров А.С., Косаченко А.Г. Ургентная гинекология: новый взгляд // Журнал акушерства и женских болезней. – 2001. – Т. L. – № 3 – С. 15–18. [Kulakov VI, Gasparov AS, Kosachenko AG. Urgent Gynecology: a new look. Zhurnal akusherstva i zhenskikh boleznei. 2001; L(3):5-18. (In Russ.)]
  9. Медведев М.В., Алтынник H.A. Эктопическая беременность // Энциклопедия ультразвуковой диагностики в акушерстве и гинекологии. Допплерография в гинекологии / Под ред. Б.И. Зыкина, М.В. Медведева – М.: Реальное время, 2000. – С. 145. [Medvedev MV, Altynnik NA. Ectopic pregnancy. In: Zykin BI, Medvedev MV, editors. Encyclopedia of ultrasonic diagnostics in obstetrics and gynecology. Dopplerography in gynecology. Moscow: Real’noe vremya; 2000. p. 145. (In Russ.)]
  10. Миндзари М.Г., Мтварадзе А.С. Прогрессирующая внематочная беременность – возможности абдоминальной и вагинальной ультразвуковой диагностики // Медицинская визуализация. – 2004. – № 3. – С. 102–104. [Mindzari MG, Mtvaradze AS. Progressing ectopic pregnancy – the possibility of abdominal and vaginal ultrasound. Medical visualization. 2004;(3):102-104. (In Russ.)]
  11. Петрова Е.В. Внематочная беременность в современных условиях // Акушерство и гинекология. – 2008. – № 1. – С. 31–33. [Petrova EV. Ectopic pregnancy in modern conditions. Akusherstvo i ginekologiia. 2008;(1):31-33. (In Russ.)]
  12. Стрижаков А.Н., Давыдов А.И., Шахламова М.Н., Белоцерковцева Л.Д. Внематочная беременность. – М.: Медицина, 2001. [Strizhakov AN, Davydov AI, Shakhlamova MN, Belotserkovtseva LD. Ectopic pregnancy. Moscow: Meditsina; 2001. (In Russ.)]
  13. Уткин Е.В., Кулавский В.А. Воспалительные заболевания органов малого таза у женщин. – М.: ГЭОТАР-Медиа, 2015. [Utkin EV, Kulavskiy VA. Pelvic inflammatory disease in women. Moscow: GEOTAR-Media; 2015. (In Russ.)]
  14. Liu F, Zhang H, Liu Y, et al. [Mifepristone in the treatment of 47 ectopic pregnancy patients]. Hunan Yi Ke Da Xue Xue Bao. 1998;23(3):265-268.
  15. Zhang W, Wang L. Mifepristone in treating ectopic pregnancy. Chin. Med. J. (Engl.). 1999;112(4):376-378.
  16. Приказ от 06.02.2017 № 15-4/10/2-729 о внедрение клинических рекомендаций (протокол лечения) «Внематочная (эктопическая) беременность» в целях совершенствования акушерско-гинекологической помощи населению.

Copyright (c) 2017 Malysheva A.A., Abramova V.N., Reznik V.A., Ruhljada N.N., Taits A.N.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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