Assesment Of Diagnosis And Clinical Approach In Ectopic Pregnancies With Analysis Of Ectopic Pregnancy Cases

Abstract

Aim: The totalitarian view of data of ectopic pregnancy cases will help practitioners to examine the treatment modalities dynamicaly and to exhibit appropriate management for patients by increasing the awareness and knowledge of professionals about the subject which will support the reduction in morbidity and mortality.Material And Methods: A total of 100 ectopic pregnancy cases managed at Ankara Education and Research Hospital were retrospectively analysed. Age, contraceptive method and previous abdominal surgery, smoking, obstetric history, symptoms, serum B-hCG levels, ultrasonographic findings, localization of ectopic pregnancy, management modalities were drawn from medical records.Results: Ectopic pregnancies were localized at tuba in 95% of cases, at ovarıum in 5% of cases. The rates of previous abdominal surgery, amenorea and previous ectopic pregnancy were 28%, 54% and 5%, respectively. Intrauterine device usage was in 21% of the cases and tubal ligation was present in 4%. βHcg values were over 2500 IU/l in 32% of cases and below 500 IU/l in 26% of cases. Adnexial mass size were between 0-25 mm in 45% of patients, between 25-40 mm in 41% of cases and greater than 40mm in 14% of cases. Abdominal pain and vaginal bleeding were in 39% and 30% of the cases. Patients free of symptoms were 4%. Related to the treatment modalities, rates of laparatomy, laparascopy, methotrexate administration and expectant management were %52, %20, %25 and %3, respectively.

Keywords

• Ectopic pregnancy,treatment

Ektopik Gebelik Olgularının Analizi İle Ektopik Gebeliklerde Tanı ve Yaklaşımın Değerlendirilmesi

Abstract

Amaç: Amacımız ektopik gebelik vakalarımızın verilerine bütüncül bir bakış ile hekimlerimizin konu ile ilgili farkındalığının ve bilgilerinin artmasına yardımcı olarak tedavi modalitelerini dinamik bir şekilde gözden geçirmelerine, hastaya uygun yaklaşımı sergileyerek mortalite ve morbiditenin azalmasına destek vermektir.Gereç ve Yöntemler: 2 yıllık süre içerisinde Ankara Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum kliniğinde ektopik gebelik tanısı ile yönetimi yapılan toplam 100 hasta retrospektif olarak analiz edildi. Yaş, kontraseptif metod, daha önceki batın cerrahisi, sigara kullanımı, obstetrik hikaye, semptomlar, serum β-Hcg seviyesi, ultrasonografi bulguları, ektopik gebeliğin yerleşimi, yaklaşım modalitileri medikal kayıtlardan çıkarıldı. Hastalar tedavi modalitelerine göre laparatomi, laparaskopik cerrahi ve metotreksat tedavisi olmak üzere 3 gruba ayrıldı.Sonuç: Vakalarımızın % 95’inde ektopik gebelik tubada, % 5’inde overde yerleşmiş idi. Hastaların %28 inde geçirilmiş batın cerrahisi, % 54 ünde amenore, % 5 inde geçirilmiş ektopik gebelik hikayesi mevcut idi. Ektopik gebelik vakalarının %21’ i rahim içi araç, % 4’ ü tüp ligasyonu ile korunuyordu. Vakaların % 32’si 2500 IU/l üzeri B-Hcg değerine sahip iken, % 26’ sı 500 IU/l’nin altında β-Hcg degerine sahipti. Ultrasonda adnexial kitle izlenen hastaların % 45’indeki kitle boyutu 0-25mm arasında ,% 41’indeki kitle boyutu 25-40mm,% 14 ‘ündeki kitle boyutu 40mm üstünde idi. Hastaların öncelikli şikayeti % 39’unda yalnız abdominal ağrı, %30’unda yalnız vajinal kanama, % 27’ sinde abdominal agrı ve vajinal kanama bir arada, %4’ ünde aktif şikayet yoktu. Hastaların yönetimi % 52’sinde laparatomi, % 20’sinde laparaskopi, % 25’inde ise yalnız methotrexate, % 3 hastada klinik izlem ile yapıldı.

Keywords

• Ektopik gebelik,tedavi

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