Clinical characteristics of patients with ectopic pregnancies treated with repeated doses of methotrexate.

Öz

ABSTRACT Aim: Dose regimens of methotrexate used in the medical treatment of ectopic pregnancy vary. In this study, factors determining single-dose and repeated-dose methotrexate regimens were investigated. Material and methods: Patients diagnosed with ectopic pregnancy and treated with methotrexate in a tertiary care center were retrospectively analyzed. Medical characteristics, ultrasonography findings, and laboratory values of patients treated with single-dose methotrexate (n=128) and patients treated with additional doses (n=30) were compared. p<0.05 was considered significant. Results: There was no significant difference between the patient and medical characteristics. The need for additional dose was less in patients with more pelvic fluid on ultrasonography (p<0.001). Patients with a day 4/day 1 β-hcg ratio of 0.8474 and above required an additional dose of methotrexate (p<0.001). Discussion: Different parameters have been defined for patient selection for effective medical treatment of ectopic pregnancy. In this study, the effects of ultrasonography findings and β-hcg levels at follow-up on patient selection were quantitatively determined. Conclusion: The combination of day 4/day 1 β-hcg ratio and ultrasonography findings may help to identify patients in need of additional doses of methotrexate.

Anahtar Kelimeler

• Beta-human chorionic gonadotropin
• Ectopic pregnancy
• Methotrexate

Metotreksat ile tedavi edilen ektopik gebeliklerde tekrarlayan doz kullanılan hastaların klinik özellikleri.

Öz

Amaç: Ektopik gebeliğin medikal tedavisinde kullanılan metotreksatın uygulama rejimleri farklılık göstermektedir. Bu çalışmada tek doz ve tekrarlayan doz metotreksat rejimlerini belirleyen faktörler araştırılmıştır. Gereç ve Yöntem: 3. basamak bir merkezdeki ektopik gebelik tanısı almış ve metotreksat ile tedavi edilmiş hastalar retrospektif olarak incelendi. Tek doz metotreksat ile tedavisi sağlanmış (n=128) ve ek doz uygulanmış (n=30) hastalara ait tıbbi özellikler, ultrasonografi bulguları ve laboratuvar değerleri karşılaştırıldı. p<0.05 değeri anlamlı kabul edildi. Bulgular: İncelenen hasta özellikleri ve tıbbi özgeçmişler arasında anlamlı fark görülmedi. Ultrasonografide pelvik serbest sıvı miktarı fazla olanlarda ek doz ihtiyacı daha az olarak görüldü (p<0.001). 4. gün / 1. gün β-hcg oranı 0.8474 ve üzerinde olan hastalarda ek doz metotreksat ihtiyacınn arttığı görüldü (p<0.001). Tartışma: Ektopik gebeliğin etkin medikal tedavisinde hasta seçimi için farklı parametreler tanımlanmıştır. Bu çalışmada tanı anındaki ultrasonografi bulgularının ve takipteki β-hcg oranlarının hasta seçimine etkileri kantitatif olarak saptanmıştır. Sonuç: Ultrasonografi bulguları ve 4. gün / 1. gün β-hcg oranının birlikte değerlendirilmesi ek doz metotreksat ihtiyacı olan hastaları belirlemeye yardımcı olabilir.

Anahtar Kelimeler

• Beta-human koryonik godadotropin
• Ektopik gebelik
• Metotreksat

Kaynakça

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