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Rupture of Ectopic Pregnancy in Woman with Very Low Beta-hCG Level (62 mIU/ml): Case Report

Year 2009, Volume: 3 Issue: 2, 124 - 126, 26.07.2009

Abstract

Although the incidence of ectopic pregnancy increases, conservative methods have been preferred for management with widespread use of transvaginal ultrasonography and technical advances in assays sensitive to P~hCG. But, the patient based treatment method should be choosen carefully, because rupture of ectopic pregnancy may be experienced at very low p -hCG levels. A patient of ruptured ectopic pregnancy with P-hCG level of 62 mIU/ml. Rupture of ectopic pregnancy may be encountered with very low or negative p-hCG levels. Hence, we should be careful during the expectant management and perform it for selected patients. Laparoscopy can be adapted in selected patients who are hemodynamically stable and who have no active bleeding, with regards to fertility desire; otherwise laparotomy should be choice of treatment.

References

  • 1. Fujishita A, Khan KN, Kitajima M, Hiraki K, Miura S, Ishimaru T, Masuzaki H. Re-evalua-tion of the indication for and limitation of laparoscopic salpingotomy for tubal pregnancy. Eur J Obs&Gynecol Reprod Biol 2008;137:210-6.
  • 2. Galstyan K, Kurzel RB. Serum beta-hCG titers do not predict ruptured ectopic pregnancy. Int J Fertil Womens Med 2006;51(1):14-6.
  • 3. Fu J, Henne MB, Blumstein S, Lathi RB. Rupture of ectopic pregnancy with minimally detectable beta-human chorionic gonadotropin levels: a report of 2 cases. J Reprod Med 2007;52(6):541-2.
  • 4. Hochner-Celnikier D, Ron M, Goshen R, Zacut D, Amir G, Yagel S. Rupture of ectopic preg- nancy following disappearance of serum beta subunit of hCG. Obstet Gynecol 1992;79(5 ( Pt 2)):826-7.
  • 5. Lurie S, Katz Z, Weissman A, Zalel Y, Caspi B. Declining beta-human chorionic gonadotropin level may provide false security that tubal pregnancy will not rupture. Eur J Obstet Gynecol Reprod Biol 1994;53(1):72-3.
  • 6. Grynberg M, Teyssedre J, Andre C, Graesslin 0. Rupture of ectopic pregnancy with negative serum B-hCG leading to hemorrhagic shock. Obstet Gynecol 2009;113:537-9.
  • 7. Saxon D, Falcone T, Mascha EJ, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy. Obstet Gynecol 1997;90(1):46-9.
  • 8. Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. Gynecol Obstet Invest 2005;60:177-80.
  • 9. Sindos M, Togia A, Sergentanis TN, Kaba-giannis A, Malamas F, Farfaras A, et al. Ruptured ectopic pregnancy: risk factors for a life-threatening condition. Arch Gynecol Obstet, article in press.
  • 10. Vermesh M. Conservative management of ectopic gestation. Fertil Steril 1989;51: 559-67.
  • 11. Chapron C, Pouly JL, Wattiez A, et al. Results of conservative laparoscopic treatment of isth-mic ectopic pregnancies: a 26 case study. Hum Reprod 1992;7:422-4.

Çok Düşük p-hCG Değeri (62 mIU/ml) ile Rüptüre Olan Ektopik Gebelik

Year 2009, Volume: 3 Issue: 2, 124 - 126, 26.07.2009

Abstract

Ektopik gebelik insidansında artış görülmesine rağmen, transvajinal ultrasonografı ve daha duyarlı P-hCG testlerinin kullanılmaya başlanmasıyla birlikte tedavide daha konservatif yöntemler tercih edilmeye başlanmıştır. Ancak bu tedavi yöntemlerinin seçiminde hastaya göre seçilmiş yaklaşımlar dikkatli bir şekilde uygulanmalıdır çünkü çok düşük p-hCG değerlerinde de ektopik gebelik rüptürüyle karşılaşılabilmektedir. p-hCG değeri 62 mIU/ml iken rüptüre olmuş bir ektopik gebelik hastası. Ektopik gebelik rüptürü ile p-hCG değeri çok düşük hatta negatif olduktan sonra da karşılaşılabilmektedir. Bu nedenle ektopik gebelik vakalarında bekle-gör yaklaşımında dikkatli olunmalı ve seçilmiş hastalarda tercih edilmelidir. Tubal rüptür durumunda ise gebelik arzusu da dikkate alınarak hemodinamik olarak dengeli, aktif kanaması olmayan hastalara laparoskopi planlanmalı; aksi takdirde laparotomi tercih edilmelidir.

Dr. Yavuz Emre ŞÜKÜR, Dr. Vugar BAYRAMOV, Dr. Batuhan ÖZMEN, Dr. Murat SÖNMEZER

References

  • 1. Fujishita A, Khan KN, Kitajima M, Hiraki K, Miura S, Ishimaru T, Masuzaki H. Re-evalua-tion of the indication for and limitation of laparoscopic salpingotomy for tubal pregnancy. Eur J Obs&Gynecol Reprod Biol 2008;137:210-6.
  • 2. Galstyan K, Kurzel RB. Serum beta-hCG titers do not predict ruptured ectopic pregnancy. Int J Fertil Womens Med 2006;51(1):14-6.
  • 3. Fu J, Henne MB, Blumstein S, Lathi RB. Rupture of ectopic pregnancy with minimally detectable beta-human chorionic gonadotropin levels: a report of 2 cases. J Reprod Med 2007;52(6):541-2.
  • 4. Hochner-Celnikier D, Ron M, Goshen R, Zacut D, Amir G, Yagel S. Rupture of ectopic preg- nancy following disappearance of serum beta subunit of hCG. Obstet Gynecol 1992;79(5 ( Pt 2)):826-7.
  • 5. Lurie S, Katz Z, Weissman A, Zalel Y, Caspi B. Declining beta-human chorionic gonadotropin level may provide false security that tubal pregnancy will not rupture. Eur J Obstet Gynecol Reprod Biol 1994;53(1):72-3.
  • 6. Grynberg M, Teyssedre J, Andre C, Graesslin 0. Rupture of ectopic pregnancy with negative serum B-hCG leading to hemorrhagic shock. Obstet Gynecol 2009;113:537-9.
  • 7. Saxon D, Falcone T, Mascha EJ, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy. Obstet Gynecol 1997;90(1):46-9.
  • 8. Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. Gynecol Obstet Invest 2005;60:177-80.
  • 9. Sindos M, Togia A, Sergentanis TN, Kaba-giannis A, Malamas F, Farfaras A, et al. Ruptured ectopic pregnancy: risk factors for a life-threatening condition. Arch Gynecol Obstet, article in press.
  • 10. Vermesh M. Conservative management of ectopic gestation. Fertil Steril 1989;51: 559-67.
  • 11. Chapron C, Pouly JL, Wattiez A, et al. Results of conservative laparoscopic treatment of isth-mic ectopic pregnancies: a 26 case study. Hum Reprod 1992;7:422-4.
There are 11 citations in total.

Details

Primary Language Turkish
Subjects Reproductive Medicine (Other)
Journal Section Case Reports
Authors

Yavuz Şükür

Publication Date July 26, 2009
Published in Issue Year 2009 Volume: 3 Issue: 2

Cite

APA Şükür, Y. (2009). Çok Düşük p-hCG Değeri (62 mIU/ml) ile Rüptüre Olan Ektopik Gebelik. Türk Tıp Dergisi, 3(2), 124-126.

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