The method of differentiated organ-preserving treatment of cervical pregnancy and pregnancy in the uterine rumen after cesarean section, depending on the data of a comprehensive ultrasound study and the level of human chorionic gonadotropin

摘要

FIELD: medicine.SUBSTANCE: after emergency hospitalization, bilateral embolization of the uterine arteries (UAE) is performed, including methotrexate administration of in the amount of 50 mg endoarterially in the presence of ultrasound signs of chorion infiltration with formation of vascular malformation and HCG level increase. The gestational sac is left. 3 days after, ultrasound and HCG control is performed. With a HCG decrease in by at least 25% and no visualization of blood flow in the chorion with ultrasound and colour Doppler mapping (CDM), the patient is released for outpatient monitoring. With blood flow persistence in the chorion, UAE is repeated with a search for these vessels. If there is insufficient decrease in the blood plasma HCG, the patient receives methotrexate into the gestational sac cavity in an amount of 2-10 mg. In the absence of ultrasound signs of chorionic growth, the gestational sac is removed simultaneously under the control of ultrasound. In the absence of bleeding and normal data of the control ultrasound after 1 day, the patient is released for outpatient monitoring. In the presence of ultrasound signs of chorionic ingrowth and decreasing level of HCG, UAE without endoarterial administration of methotrexate is performed. 3 days after, ultrasound and HCG control are performed. With a HCG decrease in by at least 10% and no visualization of blood flow in the chorion with ultrasound and CDM, the patient is released for outpatient monitoring.EFFECT: maintaining the uterus integrity and its reproductive function while reducing the duration of hospitalization.4 cl, 5 ex