Anrüptüre tubal ektopik gebeliklerde ayaktan metotreksat tedavi stratejileri

Year 2018, , 41 - 44, 24.04.2018

Alper Başbuğ , Aşkı Ellibeş Kaya , Mete Çağlar , Ali Yavuzcan

https://doi.org/10.25000/acem.406437

Abstract

Amaç: Rüptüre olmamış ektopik gebeliğin ayaktan tedavisi için
seçim kriterlerini değerlendirmek.

Yöntemler: Düzce
Üniversitesi Tıp Fakültesi, Eğitim ve Araştırma Hastanesi'nde 2012-2017 yılları
arasında tek doz intramusküler metotreksat enjeksiyonları ile tedavi edilen
toplam 124 rüptüre olmamış ektopik gebelik retrospektif olarak
değerlendirildi.

Bulgular:  Tek
doz metotreksat ile medikal tedavi 124 hastanın % 76,61'inde (n = 95)
başarılı bulundu. Başarılı olarak tedavi edilen grupta ortalama hastanede kalış
süreleri daha kısa idi (p=0,030). Metotreksat enjeksiyonunun 1.günü β-hCG
düzeyinin ektopik odak büyüklüğü ve / veya batın içinde sıvı varlığı ile
birleşmesi metotreksat ile başarılı bir şekilde tedavi edilmek üzere duyarlılık,
özgüllük ve pozitif öngörüyü anlamlı olarak arttırmıştır (duyarlılık= %70,3,
özgüllük= %86,3, pozitif kestirim değeri= %80).

Sonuç:  Başlangıç serum β-hCG seviyeleri,
ektopik odak büyüklüğü ve batında sıvı varlığı ile metotreksat tedavisine iyi
yanıt verecek hastaları, hastane yatışı gerektirmeden seçebiliriz.

Keywords

ektopik gebelik, metotreksat, ayaktan tedavi

Outpatient methotrexate treatment strategies for unruptured tubal ectopic pregnancy

Abstract

Aim: To evaluate the selection
criteria for outpatient treatment of unruptured ectopic pregnancy.

Methods: A total of 124
unruptured ectopic pregnancies that had been treated with single-dose
intramuscular methotrexate injections during the period from 2012 to 2017 at Duzce
UniversityFaculty of Medicine, Training and Research Hospital were evaluated.

Results: Success rate of the
medical treatment with single dose methotraxate was 76.61% (n = 95) of 124
patient. The mean duration of hospital stay was shorter in successful medical
treatment group (p=0.030). Combining β-hCG level at the first day of methotrexate
treatment with size of ectopic focus and/or the presence of fluid in the
abdomen significantly increased the sensitivity, specificity and positive predictivity
for successfully treated with methotrexate (sensitivity = 70.3%, specificity
=86.3%, positive predictive value =80%).

Conclusions: We can choose
patients that will be good responder to methotrexate treatment of ectopic
pregnancy without hospitalization by initial serum β-hCG values, size of
ectopic focus and the presence of fluid in the abdomen.

Keywords

outpatient treatment, ectopic pregnancy, methotrexate

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