Kliniğimizde Tedavi Edilen Tubal Ektopik Gebelik Olgularında Hemoperitonyumun Önemi ve Retrospektif Analizi

Abstract

Amaç: Bu çalışmanın amacı kliniğimizde tedavi edilen tubal ektopik gebelik olgularının hemoperitonyumun önemini ve retrospektif analizini sunmaktır. Gereç ve Yöntemler: Bu çalışmaya Ocak 2012 ile Ağustos 2013 tarihleri arasında tek merkezli kliniğimizde tubal ektopik gebelik (EP) tanısı ve tedavisi konulan 86 kadın dahil edildi. Yaş, son adet tarihi, insan koryonik gonadotropin (β-hCG) ) düzeyi, tubal EP kitlelerinin büyüklüğü ve varlığı, fetal kardiyak aktivite ve tedavi prosedürleri değerlendirildi ve karşılaştırıldı. Prediktif tedavi yöntemleri için hemoperiton varlığı ve tedavi yöntemlerinin başarısını etkileyen faktörler araştırıldı. Bulgular: olguların yaş ortalaması 29,1±5,7 (16-41) yıl idi. Ortalama β-hCG düzeyi 4448,5±8351,9 IU/L idi. 14 olguya (%16.3) laparatomi, 5 olguya (%5.8) laparoskopi, 15 olguya (%17.4) ekspektan tedavi uygulandı. MTX tedavisi başarısızlığı nedeniyle 46 olguya (%53,5) metotreksat (MTX) tedavisi, 1 olguya (%1,2) laparoskopi, 5 olguya (%5,8) laparatomi uygulandı. Tubal EP'nin MTX tedavisi ile karşılaştırıldığında, başlangıç β-hCG düzeyi (p=0,004), intraabdominal kanama olup olmadığı (p=0,03), ektopik gebelik boyutu (p=0,005) ve fetal kalp aktivitesinin varlığı (p<0,001) gibi cerrahi yönetimi etkileyen olası faktörler istatistiksel olarak anlamlı bulundu. Tek doz MTX tedavisinin başarı oranı %69.5 idi. Sonuç: Tedavi yöntemlerinde hemoperitonyumun varlığı MTX tedavisi için cerrahi tedaviye yol açan bir risk faktörü olabilir. MTX tedavisi tubal EP'de cerrahi tedaviye alternatif yöntemlerden biridir.

Keywords

• ektopik gebelik
• hemoperitonyum
• metotreksat
• cerrahi

The Importance of Hemoperitoneum and Retrospective Analysis of Tubal Ectopic Pregnancy Cases Treated in our Clinic

Abstract

Aim: The purpose of this study is to present the importance of hemoperitoneum and retrospective analysis of tubal ectopic pregnancy cases treated in our clinic. Material and Methods: This study respectively included 86 women who were diagnosed and treated for tubal ectopic pregnancy (EP) in our single-centre clinic between January 2012 and August 2013. Age, date of last menstrual period, human chorionic gonadotropin (β-hCG) level, the size and the presence of tubal EP masses, fetal cardiac activity and treatment procedures were evaluated and compared. The presence of hemoperitoneum for predictive treatment methods and factors that affecting the success of treatment methods were investigated. Results: The mean age of the patients was 29.1±5.7 (16-41) years. Mean β-hCG level was 4448,5±8351,9 IU/L. Laparatomy was performed to 14 patients (16.3%), laparoscopy to 5 patients (5.8%), expectant management to 15 patients (17.4%). Methotrexate (MTX) treatment was given to 46 patients (53.5%) and laparoscopy was performed to 1 patient (1.2%) and laparatomy to 5 patients (5.8%) due to MTX treatment failure in 6 patients. Compared with the MTX treatment of tubal EP, the possible factors that affecting surgical management, such as the initial β-hCG level (p=0.004), whether there is hemorrhage in the abdominal cavity (p=0.03), the size of ectopic pregnancy mass (p=.005) and the presence of fetal heart activity (p<0.001) were found to be statistically significant. The success rate single-dose MTX treatment was 69.5%. Conclusion: The presence of hemoperitoneum in treatment methods may be a risk factor for MTX treatment, leading to surgical treatment. MTX treatment is one of alternative method to surgical treatment in tubal EP.

Keywords

• ectopic pregnancy
• hemoperitoneum
• methotrexate
• surgery

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