Tubal passage control after methotrexate treatment in ectopic pregnancies

Abstract

Objectives: In this study, it was aimed to evaluate the results of ipsilateral tubal passage control in the cases treated with methotrexate (MTX). Materials and methods: Totally 30 patients aged between 21 and 40 years who have received single dose MTX treatment due to ectopic pregnancy was included. All patients were as hemodynamically stabile. Serum beta human chorionic gonadotropin (BhCG) levels and ultrasonographic findings prior to the MTX treatment were recorded. Patients were re-evaluated 6 months after serum BhCG levels became negative for the outcome of treatment. Results: The mean age of the 30 cases was 30.6±4.4 years. The BhCG levels of the cases was changing between 160 and 10910, their average is 2387±2499 IU/L. The MTX dose was changing between 50 to 100 mg, with average of 67.7±13.5 mg. Four (13.3%) of the cases received additional dose of MTX. Laparotomy was performed in 3 (10%) cases due to tubal rupture developing during the treatment. Among 27 cases on whom the tubal passage control is made 6 months after the treatment, tubal passage was found to be open in 22 (81.5%) of the cases and closed in 5 (18.5%). There was no significant difference between the BhCG levels of cases with open and closed tubal passage (p>0.05). Conclusion: The medical treatment to be applied on non-ruptured ectopic pregnancies has many advantages. Less tubal damage occurs by the medical treatment, it decreases the morbidity for anesthesia and surgery. J Clin Exp Invest 2011; 2 (4): 400-403

Keywords

• Ectopic pregnancy, methotrexate, tubal passage

Tubal passage control after methotrexate treatment in ectopic pregnancies

Öz

Amaç: Bu çalışmada metotreksat (MTX) ile tedavi olmuş ektopik gebelik olgularında ipsilateral tubal pasaj kontrolü yapılarak sonuçların değerlendirilmesi amaçlandı. Gereç ve yöntem: Çalışmaya ektopik gebelik nedeniyle tek doz MTX tedavisi almış yaşları 21 ile 40 arasında değişmekte olan 30 hasta dahil edildi. Hastaların tümü hemodinamik olarak stabildi. MTX tedavisine başlamadan önceki serum beta human chorionic gonadotropin (BhCG) seviyeleri, ultrasonografi bulguları kaydedildi. Serum BhCG düzeyleri negatif olduktan 6 ay sonra tubal pasaj kontrolü yapılan hastalar tedavi sonuçları ile tekrar değerlendirildi. Bulgular: Çalışmaya alınan 30 olgunun yaş ortalaması 30.6±4.4 yıl idi. Olguların BhCG düzeyleri 160 ile 10910 IU/L arasında değişmekte olup, ortalaması 2387±2499 IU/L idi. Kullandıkları MTX dozları 50 mg ile 100 mg arasında değişmekte olup, ortalaması 67.7±13.5 mg idi. Olguların 4\'üne (%13.3) ek doz MTX uygulandı. Olguların 3\'üne (%10) tedavi sırasında gelişen tubal rüptür nedeniyle laparotomi yapıldı. Tedaviden 6 ay sonra tubal pasaj kontrolü yapılan 27 olgunun, 22\'sinin (%81.5) tubal pasajı açık, 5\'inin (%18.5) kapalı bulundu. Tubal pasajı açık olan olgular ile kapalı olan olguların BhCG düzeyleri arasında istatistiksel olarak anlamlı bir farklılık bulunmadı (p>0.05). Sonuç: Rüptüre olmamış ektopik gebeliklerde uygulanacak medikal tedavi ile daha az tubal hasar meydana gelmekte, anesteziye ve cerrahiye ait morbidite azaltmaktadır.

Anahtar Kelimeler

• Ektopik gebelik, metotreksat, tubal pasaj

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