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

Yıl 2024, Cilt: 57 Sayı: 2, 49 - 52, 31.08.2024
https://doi.org/10.20492/aeahtd.1371505

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.

Kaynakça

  • 1. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224- 3230. doi: 10.1093/humrep/17.12.3224.
  • 2. Atabekoğlu CS, Gözüküçük M, Özkavukçu S, Sönmezer M. Rare presentation of ectopic pregnancy following IVF-ET: live twin gestation in the same fallopian tube. Human Fertility. 2009;12(2):122-124. doi: 10.1080/14647270902852812.
  • 3. Van Den Eeden SK, Shan J, Bruce C, Glasser M. Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol.2005;105(5):1052-1057. doi: 10.1097/01.AOG.0000158860.26939.2d.
  • 4. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States.Obstet Gynecol. 2010;115(3):495-502.doi:10.1097/ AOG.0b013e3181d0c328.
  • 5. Mukherjee R, Samanta S. Surgical emergencies in pregnancy in the era of modern diagnostics and treatment. Taiwan J Obstet Gynecol. 2019;58(2):177-182. doi:10.1016/j. tjog.2019.01.001.
  • 6. Farquhar CM. Ectopic pregnancy. Lancet. 2005;366(9485):583-591. doi: 10.1016/s0140- 6736(05)67103-6.
  • 7. Hajenius PJ, Mol F, Mol BWJ, Bossuyt PMM, Ankum WM, Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database of Systematic Reviews. 2007(1). doi: 10.1002/14651858.CD000324.pub2.
  • 8. ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstet Gynecol. Mar 2018;131(3):e91-e103. doi: 10.1097/ aog.0000000000002560.
  • 9. Lipscomb GH, Givens VM, Meyer NL, Bran D. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol. 2005;192(6):1844-1847; discussion 1847-1848. doi: 10.1016/j.ajog.2004.12.061.
  • 10. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol. 2003;101(4):778-784. doi: 10.1016/s0029- 7844(02)03158-7.
  • 11. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 2013;100(3):638-644. doi: 10.1016/j.fertnstert. 2013.06.013.
  • 12. Alur-Gupta S, Cooney LG, Senapati S, Sammel MD, Barnhart KT. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol.2019;221(2):95-108. doi: 10.1016/j. ajog.2019.01.002.
  • 13. Tsakiridis I, Giouleka S, Mamopoulos A, Athanasiadis A, Dagklis T. Diagnosis and Management of Ectopic Pregnancy: A Comparative Review of Major National Guidelines. Obstet Gynecol Surv. 2020;75(10):611-623. doi: 10.1097/ ogx.0000000000000832.
  • 14. Shiravani Z, Atbaei S, Namavar Jahromi B, et al. Comparing four different methods for the management of ectopic pregnancy: A cross-sectional study. Int J Reprod Biomed. 2021;20(3):177-184. doi: 10.18502/ijrm.v20i3.10709.
  • 15. Gungorduk K, Asicioglu O, Yildirim G, Gungorduk OC, Besimoglu B, Ark C. Comparison of single-dose and two-dose methotrexate protocols for the treatment of unruptured ectopic pregnancy. J Obstet Gynaecol. 2011;31(4):330-334. doi: 10.3109/01443615.2011.560301.
  • 16. Brunello J, Guerby P, Cartoux C, et al. Can early βhCG change and baseline progesterone level predict treatment outcome in patients receiving single dose Methotrexate protocol for tubal ectopic pregnancy? Arch Gynecol Obstet. 2019;299(3):741-745. doi: 10.1007/s00404-019-05068- 1.
  • 17. Yıldırım A, Cırık DA, Altay M, Gelisen O. Early prediction for the requirement of second or third dose methotrexate in women with ectopic pregnancy, treated with single-dose regimen. Arch Gynecol Obstet. 2015;291(6):1327-1332. doi: 10.1007/s00404-014-3593-x.
  • 18. Deniz S, Ali B, Canan U, et al. Evaluation of the parameters in predicting single-dose methotrexate therapy success for ectopic pregnancy. J Obstet Gynaecol Res. 2024;50(5):856-863. doi: 10.1111/jog.15923.
  • 19. Abuduxukuer R, Chen X, Ni J, Li S, Lu W. Day 4 and day 0 neutrophil-to-lymphocyte ratios as predictors of treatment failure with single-dose methotrexate for ectopic pregnancies. Int J Gynaecol Obstet. 2024;165(1):131-137. doi: 10.1002/ijgo.15248

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

Yıl 2024, Cilt: 57 Sayı: 2, 49 - 52, 31.08.2024
https://doi.org/10.20492/aeahtd.1371505

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.

Kaynakça

  • 1. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224- 3230. doi: 10.1093/humrep/17.12.3224.
  • 2. Atabekoğlu CS, Gözüküçük M, Özkavukçu S, Sönmezer M. Rare presentation of ectopic pregnancy following IVF-ET: live twin gestation in the same fallopian tube. Human Fertility. 2009;12(2):122-124. doi: 10.1080/14647270902852812.
  • 3. Van Den Eeden SK, Shan J, Bruce C, Glasser M. Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol.2005;105(5):1052-1057. doi: 10.1097/01.AOG.0000158860.26939.2d.
  • 4. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States.Obstet Gynecol. 2010;115(3):495-502.doi:10.1097/ AOG.0b013e3181d0c328.
  • 5. Mukherjee R, Samanta S. Surgical emergencies in pregnancy in the era of modern diagnostics and treatment. Taiwan J Obstet Gynecol. 2019;58(2):177-182. doi:10.1016/j. tjog.2019.01.001.
  • 6. Farquhar CM. Ectopic pregnancy. Lancet. 2005;366(9485):583-591. doi: 10.1016/s0140- 6736(05)67103-6.
  • 7. Hajenius PJ, Mol F, Mol BWJ, Bossuyt PMM, Ankum WM, Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database of Systematic Reviews. 2007(1). doi: 10.1002/14651858.CD000324.pub2.
  • 8. ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstet Gynecol. Mar 2018;131(3):e91-e103. doi: 10.1097/ aog.0000000000002560.
  • 9. Lipscomb GH, Givens VM, Meyer NL, Bran D. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol. 2005;192(6):1844-1847; discussion 1847-1848. doi: 10.1016/j.ajog.2004.12.061.
  • 10. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol. 2003;101(4):778-784. doi: 10.1016/s0029- 7844(02)03158-7.
  • 11. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 2013;100(3):638-644. doi: 10.1016/j.fertnstert. 2013.06.013.
  • 12. Alur-Gupta S, Cooney LG, Senapati S, Sammel MD, Barnhart KT. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol.2019;221(2):95-108. doi: 10.1016/j. ajog.2019.01.002.
  • 13. Tsakiridis I, Giouleka S, Mamopoulos A, Athanasiadis A, Dagklis T. Diagnosis and Management of Ectopic Pregnancy: A Comparative Review of Major National Guidelines. Obstet Gynecol Surv. 2020;75(10):611-623. doi: 10.1097/ ogx.0000000000000832.
  • 14. Shiravani Z, Atbaei S, Namavar Jahromi B, et al. Comparing four different methods for the management of ectopic pregnancy: A cross-sectional study. Int J Reprod Biomed. 2021;20(3):177-184. doi: 10.18502/ijrm.v20i3.10709.
  • 15. Gungorduk K, Asicioglu O, Yildirim G, Gungorduk OC, Besimoglu B, Ark C. Comparison of single-dose and two-dose methotrexate protocols for the treatment of unruptured ectopic pregnancy. J Obstet Gynaecol. 2011;31(4):330-334. doi: 10.3109/01443615.2011.560301.
  • 16. Brunello J, Guerby P, Cartoux C, et al. Can early βhCG change and baseline progesterone level predict treatment outcome in patients receiving single dose Methotrexate protocol for tubal ectopic pregnancy? Arch Gynecol Obstet. 2019;299(3):741-745. doi: 10.1007/s00404-019-05068- 1.
  • 17. Yıldırım A, Cırık DA, Altay M, Gelisen O. Early prediction for the requirement of second or third dose methotrexate in women with ectopic pregnancy, treated with single-dose regimen. Arch Gynecol Obstet. 2015;291(6):1327-1332. doi: 10.1007/s00404-014-3593-x.
  • 18. Deniz S, Ali B, Canan U, et al. Evaluation of the parameters in predicting single-dose methotrexate therapy success for ectopic pregnancy. J Obstet Gynaecol Res. 2024;50(5):856-863. doi: 10.1111/jog.15923.
  • 19. Abuduxukuer R, Chen X, Ni J, Li S, Lu W. Day 4 and day 0 neutrophil-to-lymphocyte ratios as predictors of treatment failure with single-dose methotrexate for ectopic pregnancies. Int J Gynaecol Obstet. 2024;165(1):131-137. doi: 10.1002/ijgo.15248
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kadın Hastalıkları ve Doğum
Bölüm Araştırma Makalesi
Yazarlar

Sabri Kurtay 0000-0003-0867-6972

Murat Gözüküçük 0000-0002-4418-7570

Gamze Doğan Yangır 0009-0006-6031-314X

Yusuf Ustun 0000-0003-1529-2555

Yayımlanma Tarihi 31 Ağustos 2024
Gönderilme Tarihi 5 Ekim 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 57 Sayı: 2

Kaynak Göster

AMA Kurtay S, Gözüküçük M, Doğan Yangır G, Ustun Y. Clinical characteristics of patients with ectopic pregnancies treated with repeated doses of methotrexate. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. Ağustos 2024;57(2):49-52. doi:10.20492/aeahtd.1371505