Updated To International Guidelines Approach to Ectopic Pregnancies

Öz

Ectopic (extrauterine) pregnancy, blastocyst is the location of the uterus anywhere outside the endometrial cavity. It constitutes 1% to 2% of all pregnancies reported in the world. In our country, there is an increase in the incidence of ectopic pregnancy due to the decrease in the age of sexual intercourse in recent years, the occurrence of sexually transmitted infections more frequently, high cesarean rate, increased participation of advanced age pregnancies with the more active participation of women in working life. Attention is drawn to the importance of education, care and counseling in increasing the success of the selected treatment. In this context, midwives and nurses who take an active role in emergency obstetric care and management are expected to provide appropriate care and counseling services about ectopic pregnancy. In this review; In addition to our existing information on ectopic pregnancy, it is aimed to review the current approach in the gynecology literature, accompanied by guides who are the reference source. In the compilation of the article; Recommendations of the American College of Obstetrics and Gynecology (ACOG), the Royal College of Obstetrics and Gynecology (RCOG), National Institute of Clinical Practices (NICE) and the American Academy of Family Physicians (AAFP) were examined. In the management of ectopic pregnancy, which is the most common cause of maternal deaths due to first trimester pregnancy in our country, it is valuable for the midwives and nurses to follow the current literature in terms of protecting and promoting women's health.

Anahtar Kelimeler

• Ectopic pregnancy
• Guideline
• Nursing
• Midwifery

Güncellenmiş Uluslararası Rehberler Doğrultusunda Ektopik Gebeliklere Yaklaşım

Öz

Ektopik (ekstrauterin, dış) gebelik blastokistin uterusun endometriyal kavitesi dışında herhangi bir yere yerleşmesidir. Dünyada rapor edilen tüm gebeliklerin %1-2’sini oluşturur. Ülkemizde son yıllarda cinsel ilişki yaşının düşmesi ile cinsel yolla geçen enfeksiyonların daha sık görülmeye başlaması, sezaryen oranındaki yükseklik, kadınların çalışma hayatına daha aktif katılmalarıyla ileri yaş gebeliklerin artması gibi nedenlerle dış gebelik görülme insidansında artış söz konusudur. Seçilen tedavinin başarısının artmasında eğitim, bakım ve danışmanlığın önemine dikkat çekilmektedir. Bu kapsamda acil obstetrik bakım ve yönetiminde aktif rol alan ebelerin ve hemşirelerin dış gebelik hakkında uygun bakım ve danışmanlık hizmetini sunmaları beklenmektedir. Bu derlemede; dış gebelik konusunda var olan bilgilerimize ek olarak jinekoloji literatüründe başvuru kaynağı olan rehberler eşliğinde güncel yaklaşımı gözden geçirmek amaçlanmıştır. Makalenin derlenmesinde; Amerikan Obstetrik ve Jinekoloji Koleji (ACOG), Royal Obstetrik ve Jinekoloji Koleji (RCOG), İngiltere Ulusal Klinik Uygulamaları Mükemmeliyet Enstitüsü (NICE) ve Amerikan Aile Hekimleri Akademisi (AAFP) önerileri incelenmiştir. Ülkemizde ilk trimester gebeliğe bağlı anne ölümlerinin en sık nedeni olan ektopik gebeliğin yönetiminde koruyucu sağlık hizmetleri kapsamında ebe ve hemşirelerin güncel literatürü takip etmeleri kadın sağlığının korunması ve yükseltilmesi açısından değerlidir.

Anahtar Kelimeler

• Ektopik gebelik
• Rehber
• Hemşirelik
• Ebelik

Kaynakça

1. 1. Hendriks, E., Rosenberg, R., & Prine, L. Ectopic pregnancy: diagnosis and management. American family physician 2020;101(10): 599-606.
2. 2. Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ. On behalf of the Royal College of Obstetricians and Gynecologists. Diagnosis and management of ectopic pregnancy. British Journal of Obstetrics and Gynaecology 2016;123:15–55.
3. 3. American College of Obstetricians and Gynaecologists. ACOG Replaces Practice Bulletin Number 191: Tubal Ectopic Pregnancy. Obstetrics & Gynaecology 2018;131(3): E91-E103.
4. 4. Sabharwal M, Sabharwal S, Chhabra N. Practical Guide in Reproductive Surgery. 1st edition. Gita Mukherjee G, Pal B, Khastgir G. Jaypee Brothers Medical Publishers; 2018: 116-124.
5. 5. Yıldız A, Doğan O. Management and fertility rates of ectopic pregnancies: 5 years single center research. Journal of Clinical Obstetrics & Gynaecology 2016;26(2):93-97.
6. 6. Ferraretti AP, Goossens V, Kupka M, Bhattacharya S, de Mouzon J, Castilla JA, et al. Assisted reproductive technology in Europe, 2009: results generated from European registers by ESHRE. Human Reproduction 2013;28(9):2318-2331.
7. 7. Akan S, Ediz C, Kızılkan YE, Tavukçu HH, Hayit H, Yılmaz Ö. Evulation of male military staff’s level of knowledge about sexually transmitted diseases. The New Journal of Urology 2019;14(3):152-159.
8. 8. Akdemir S, Davarcıoğlu Özaktaş F, Aksoy N. Women’s status in labor market in Turkey and other selected countries. Karadeniz Uluslararası Bilimsel Dergisi 2019;43:184-202.

9. 9. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. 2018 Turkey Demographic and Health Survey. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK, 2019, Ankara.
10. 10. Backman T, Rauramo I, Huhtala S, Kuskenvuo M. Pregnancy during the use of levonorgestrel intrauterine system. American Journal Obstetric Gynecology 2004;190:50-4.
11. 11. Webster K, Eadon H, Fishburn S, Kumar G. Ectopic pregnancy and miscarriage: diagnosis and initial management: Summary of updated NICE guidance. British Medical Journal 2019; 367.
12. 12. Craig LB, Khan S. Expectant management of ectopic pregnancy. Clinical Obstetrics Gynaecology 2012;55:461–70.
13. 13. NICE Pathways. Managing tubal ectopic pregnancy URL: http://pathways.nice.org.uk/pathways/ectopic-pregnancy-and-miscarriage 20 Kasım 2020.
14. 14. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: A meta-analysis comparing “single dose” and “multi dose” regimens. Obstetrics & Gynaecology 2003;101(4):778-784.
15. 15. Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertility and Sterility 1982;37(6):851-2.
16. 16. Alper AGÖ, Büyükbayrak EE, Bayramoğlu MB, Karşıdağ AYK, Kars B, Pirimoğlu ZM, et al. Treatment approaches in ectopic pregnancy: A four year retrospective analysis of a tertiary referral center. Journal of Clinical Obstetrics & Gynaecology 2010;20(6):362-366.
17. 17. Stovall TG, Ling FW, Gray LA. Single dose methotrexate for treatment of ectopic pregnancy. Obstetric Gynaecology 1991;77(5):754-7.
18. 18. Odejinmi F, Huff KO, Oliver R. Individualisation of intervention for tubal ectopic pregnancy: historical perspectives and the modern evidence based management of ectopic pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology 2017;69–75.
19. 19. Alur-Gupta S, Cooney LG, Senapati S, Sammel MD, Barnhart KT. Two doses versus single dose of methotrexate for treatment of ectopic pregnancy: A meta-analysis. American Journal of Obstetrics and Gynaecology 2019;95-108.
20. 20. Tenore JL. Ectopic pregnancy. American Family Physician. 2000;61(4):1080-1088.
21. 21. Uğurel V, Aslan MM. The alternating successive use of two treatment modalities in two cervical pregnancy cases. Fırat Tıp Dergisi 2015;20(3):175-178.
22. 22. Balcı O, Ercan F, Avunduk MC. Ruptured ovarian pregnancy and its laparoscopic management: Case report. Şişli Etfal Tıp Bülteni 2016;50(4):334-337.
23. 23. Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S. The diagnosis and treatment of ectopic pregnancy. Deutsches Ärzteblatt International 2015;112(41):693.
24. 24. Şilfeler DB, Güngören A, Dolapçıoğlu K, Karateke A, Güney Ç, Akın MM, et al. Primary abdominal pregnancy: A case report. The Journal of Kartal Training and Research Hospital 2011;22(1):35-37.
25. 25. Biberoğlu EH, Kırbaş A, Daglar HK, Çelen Ş, Çaglar T, Erkaya S, et al. Sezaryen Skar Ektopik Gebelik: Olgu Serisi. Jinekoloji Obstetrik ve Neonatoloji Tıp Dergisi 2016;13:4-5.
26. 26. Kurt S, Uyar İ, Gürbüz T, Arıcı A, Demirtaş Ö, Taşyurt A. Treatment of cesarian scar pregnancy with vacuum curettage after systemic methotrexate administration: Report of two cases. Journal of Clinical Obstetrics & Gynaecology 2013;23(2):123-126.