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Türkiye’de bulunan tersiyer bir merkezdeki non-tubal ektopik gebeliklerin retrospektif değerlendirilmesi

Year 2019, Volume: 1 Issue: 1, 1 - 6, 30.12.2019

Abstract

Amaç: Non-tubal ektopik gebelikler tüm ektopik gebeliklerin %5 veya daha azını oluştursa da ektopik gebeliğe bağlı ölümlerin yaklaşık %20’sinden sorumludurlar. Non-tubal ektopik gebeliklerin klinik olarak tanı ve tedavisi zordur ve tedavi seçenekleri geleneksel olarak gelecekteki fertiliteyi etkileyecek temel cerrahi prosedürleri içermektedir. Bu çalışmanın amacı, Türkiye’de bulunan üçüncü basamak bir merkezdeki non-tubal ektopik gebeliklerin insidansını tespit etmek ve bu hastaları tubal ektopik gebeliklerden ayırt edebilmemizi sağlayacak olası farklılıkları ortaya koymaktır. 

Gereç ve Yöntem: Bu çalışmada olgular retrospektif olarak taranarak tubal ve non-tubal ektopik gebeliklerdeki hasta özellikleri ve özel incelemeleri kıyaslanmıştır. Histolojik olarak doğrulanmış 197 ektopik gebelik, iki servikal ve bir term abdominal gebelik olgusunun kayıtları analiz edilmiştir. 

Bulgular: İkiyüz ektopik gebelik olgusunun 11’i (%5.5) non-tubal, 189’u tubal ektopik gebelik şeklinde tespit edilmiştir. Non-tubal ve tubal ektopik gebelikler arasında vajinal kanama ve rektal ağrı semptomları dışında anlamlı bir fark bulunmamıştır. Vajinal kanama ve rektal ağrı non-tubal grubunda anlamlı şekilde fazla görülmüştür (sırasıyla, p=0.004 ve p=0.016).

Sonuç: Ektopik gebelik şüphesi olan bir hastada özellikle vajinal kanama ve rektal ağrı mevcutsa non-tubal lokalizasyonun olabileceği akılda tutulmalıdır.

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References

  • 1. Bakken IJ, Skjeldestad FE. Time trends in ectopic pregnancies in a Norwegian country 1970-2004, a population-based study. Hum Reprod 2006;21:3132-6.
  • 2. Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol 2012;206:289-99.
  • 3. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066-74.
  • 4. Malak M, Tawfeeq T, Holzer H, Tulandi T. 2011. Risk factors for ectopic pregnancy after in vitro fertilization treatment. J Obstet Gynaecol Can 2011;33:617-9.
  • 5. Oliver R, Malik M, Morris J. Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature. Arch Gynecol Obstet 2007;276:125-31.
  • 6. Chang Y, Kay N, Chen YH, Chen HS, Tsai EM. Resectoscopic treatment of ectopic pregnancy in previous cesarean delivery scar defect with vasopressin injection. Fertil Steril 2011;96:e80-2.
  • 7. Dorfman SF, Grimes DA, Cates W Jr, Binkin NJ, Kafrissen ME, O'Reilly KR. Ectopic pregnancy mortality, United States, 1979 to 1980: clinical aspects. Obstet Gynecol 1984;64:386-90.
  • 8. Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009;23:529-38.
  • 9. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002;17:3224-30.
  • 10. Gun M, Mavrogiorgis M. Cervical ectopic pregnancy: a case report and literature review. Ultrasound Obstet Gynecol 2002;19:297-301.
  • 11. Pisarska MD, Carson SA. Incidence and risk factors for ectopic pregnancy. Clin Obstet Gynecol 1999;42:2-8.
  • 12. de Boer CN. Ectopic pregnancy presenting as intermittent rectal bleeding and anemia. A case report. Int J Gynaecol Obstet 1986;24:379-81.
  • 13. Saravanane C, Robinson Smile S, Chandra SS, Habeebullah S. Rectal bleeding: a rare complication of abdominal pregnancy. Aust N Z J Obstet Gynaecol 1997;37:124-5.
  • 14. Erwin EA, Counselman FL. Ectopic pregnancy presenting as rectal pain. Am J Emerg Med 2007;25:221-2.
  • 15. Atrash HK, Friede A, Hogue CJ. Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol 1987;69:333-7.
  • 16. Warshal DP, Fultz PJ, Dawson AE, Del Priore G, DuBeshter B. Interstitial pregnancy complicated by rectal bleeding. Am J Obstet Gynecol 1996;175:1373-5.
  • 17. Koc I, Schumacher R, Campbell O, Turkyilmaz AS, Ergocmen B. 2005. The Turkey national maternal mortality study. Page: 62. [http://www.hips.hacettepe.edu.tr/uaop_ankara/UAOC_ana_rapor.pdf (accessed on16.05.2012)]
  • 18. National Maternal Mortality Survey, Turkey, 2010. [www.tusak.saglik.gov.tr/EN/dosya/healthstatisticsyearbook.2010.pdf (accessed on 16.05.2012)]
  • 19. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118 Suppl 1:1-203.
  • 20. Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol 2003;157:185-94.
  • 21. Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol 2006;46:521-7.
  • 22. Menon S, Sammel MD, Vichnin M, Barnhart KT. Risk factors for ectopic pregnancy:a comparison between adults and adolescent women. J Pediatr Adolesc Gynecol 2007;20:181-5.

A retrospective review of non-tubal ectopic pregnancies in a tertiary unit in Turkey

Year 2019, Volume: 1 Issue: 1, 1 - 6, 30.12.2019

Abstract

Objective: Although non-tubal ectopic pregnancies represent 5% or less of all ectopic pregnancies, they account for approximately 20% of the mortalities attributed to ectopic gestations. Diagnosis and management of non-tubal ectopic pregnancies are clinically challenging and the treatment alternatives have traditionally included major surgical procedures, which affect future fertility. The aim of this study was to establish the incidence of non-tubal ectopic pregnancies in a tertiary unit in Turkey and to elucidate any differences that may discriminate patients from those with tubal ectopic pregnancy. 

Material and Method: This was a retrospective review of cases; comparing patient features and special investigation in patients with tubal and non-tubal ectopic pregnancy. The records of the 197 histologically confirmed ectopic pregnancies and two cervical and one term abdominal gestations were analyzed. 

Results: Eleven of 200 (5.5%) ectopic pregnancies were found to be non-tubal and the remaining 189 were tubal pregnancies. There was no significant difference between non-tubal and tubal ectopic pregnancies except for vaginal bleeding and rectal pain symptoms. Vaginal bleeding and rectal pain were observed significantly more frequent in the non-tubal group (p=0.004 and 0.016, respectively). 

Conclusion: Non-tubal location may be considered in patients with the suspicion of ectopic pregnancy especially if there are vaginal bleeding and rectal pain.

References

  • 1. Bakken IJ, Skjeldestad FE. Time trends in ectopic pregnancies in a Norwegian country 1970-2004, a population-based study. Hum Reprod 2006;21:3132-6.
  • 2. Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol 2012;206:289-99.
  • 3. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066-74.
  • 4. Malak M, Tawfeeq T, Holzer H, Tulandi T. 2011. Risk factors for ectopic pregnancy after in vitro fertilization treatment. J Obstet Gynaecol Can 2011;33:617-9.
  • 5. Oliver R, Malik M, Morris J. Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature. Arch Gynecol Obstet 2007;276:125-31.
  • 6. Chang Y, Kay N, Chen YH, Chen HS, Tsai EM. Resectoscopic treatment of ectopic pregnancy in previous cesarean delivery scar defect with vasopressin injection. Fertil Steril 2011;96:e80-2.
  • 7. Dorfman SF, Grimes DA, Cates W Jr, Binkin NJ, Kafrissen ME, O'Reilly KR. Ectopic pregnancy mortality, United States, 1979 to 1980: clinical aspects. Obstet Gynecol 1984;64:386-90.
  • 8. Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009;23:529-38.
  • 9. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002;17:3224-30.
  • 10. Gun M, Mavrogiorgis M. Cervical ectopic pregnancy: a case report and literature review. Ultrasound Obstet Gynecol 2002;19:297-301.
  • 11. Pisarska MD, Carson SA. Incidence and risk factors for ectopic pregnancy. Clin Obstet Gynecol 1999;42:2-8.
  • 12. de Boer CN. Ectopic pregnancy presenting as intermittent rectal bleeding and anemia. A case report. Int J Gynaecol Obstet 1986;24:379-81.
  • 13. Saravanane C, Robinson Smile S, Chandra SS, Habeebullah S. Rectal bleeding: a rare complication of abdominal pregnancy. Aust N Z J Obstet Gynaecol 1997;37:124-5.
  • 14. Erwin EA, Counselman FL. Ectopic pregnancy presenting as rectal pain. Am J Emerg Med 2007;25:221-2.
  • 15. Atrash HK, Friede A, Hogue CJ. Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol 1987;69:333-7.
  • 16. Warshal DP, Fultz PJ, Dawson AE, Del Priore G, DuBeshter B. Interstitial pregnancy complicated by rectal bleeding. Am J Obstet Gynecol 1996;175:1373-5.
  • 17. Koc I, Schumacher R, Campbell O, Turkyilmaz AS, Ergocmen B. 2005. The Turkey national maternal mortality study. Page: 62. [http://www.hips.hacettepe.edu.tr/uaop_ankara/UAOC_ana_rapor.pdf (accessed on16.05.2012)]
  • 18. National Maternal Mortality Survey, Turkey, 2010. [www.tusak.saglik.gov.tr/EN/dosya/healthstatisticsyearbook.2010.pdf (accessed on 16.05.2012)]
  • 19. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118 Suppl 1:1-203.
  • 20. Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol 2003;157:185-94.
  • 21. Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol 2006;46:521-7.
  • 22. Menon S, Sammel MD, Vichnin M, Barnhart KT. Risk factors for ectopic pregnancy:a comparison between adults and adolescent women. J Pediatr Adolesc Gynecol 2007;20:181-5.
There are 22 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Article
Authors

Ömer Lütfi Tapısız 0000-0002-7128-8086

Sabri Cavkaytar 0000-0003-1584-8568

Hakan Aytan 0000-0002-2553-7715

Görkem Tuncay 0000-0003-3994-4263

Turgut Var 0000-0002-4479-1399

Hüseyin Yeşilyurt 0000-0003-2688-9285

Publication Date December 30, 2019
Acceptance Date December 28, 2019
Published in Issue Year 2019 Volume: 1 Issue: 1

Cite

APA Tapısız, Ö. L., Cavkaytar, S., Aytan, H., Tuncay, G., et al. (2019). A retrospective review of non-tubal ectopic pregnancies in a tertiary unit in Turkey. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, 1(1), 1-6.
AMA Tapısız ÖL, Cavkaytar S, Aytan H, Tuncay G, Var T, Yeşilyurt H. A retrospective review of non-tubal ectopic pregnancies in a tertiary unit in Turkey. Türk Kadın Sağlığı ve Neonatoloji Dergisi. December 2019;1(1):1-6.
Chicago Tapısız, Ömer Lütfi, Sabri Cavkaytar, Hakan Aytan, Görkem Tuncay, Turgut Var, and Hüseyin Yeşilyurt. “A Retrospective Review of Non-Tubal Ectopic Pregnancies in a Tertiary Unit in Turkey”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi 1, no. 1 (December 2019): 1-6.
EndNote Tapısız ÖL, Cavkaytar S, Aytan H, Tuncay G, Var T, Yeşilyurt H (December 1, 2019) A retrospective review of non-tubal ectopic pregnancies in a tertiary unit in Turkey. Türk Kadın Sağlığı ve Neonatoloji Dergisi 1 1 1–6.
IEEE Ö. L. Tapısız, S. Cavkaytar, H. Aytan, G. Tuncay, T. Var, and H. Yeşilyurt, “A retrospective review of non-tubal ectopic pregnancies in a tertiary unit in Turkey”, Türk Kadın Sağlığı ve Neonatoloji Dergisi, vol. 1, no. 1, pp. 1–6, 2019.
ISNAD Tapısız, Ömer Lütfi et al. “A Retrospective Review of Non-Tubal Ectopic Pregnancies in a Tertiary Unit in Turkey”. Türk Kadın Sağlığı ve Neonatoloji Dergisi 1/1 (December 2019), 1-6.
JAMA Tapısız ÖL, Cavkaytar S, Aytan H, Tuncay G, Var T, Yeşilyurt H. A retrospective review of non-tubal ectopic pregnancies in a tertiary unit in Turkey. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2019;1:1–6.
MLA Tapısız, Ömer Lütfi et al. “A Retrospective Review of Non-Tubal Ectopic Pregnancies in a Tertiary Unit in Turkey”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, vol. 1, no. 1, 2019, pp. 1-6.
Vancouver Tapısız ÖL, Cavkaytar S, Aytan H, Tuncay G, Var T, Yeşilyurt H. A retrospective review of non-tubal ectopic pregnancies in a tertiary unit in Turkey. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2019;1(1):1-6.