Tubal ektopik gebeliklerde çoklu doz metotreksat tedavisinin analizi

Year 2022, Volume: 47 Issue: 1, 397 - 404, 31.03.2022

Furkan Çetin , Neslihan Bayramoğlu Tepe , Seyhun Sucu , Muhammed Hanifi Bademkıran , İrfan Kutlar

https://doi.org/10.17826/cumj.1037172

Abstract

Amaç: Tubal ektopik gebelik hastalarında ardışık çoklu doz metotreksat tedavisinin başarı oranı ile tedavi başarısına etki eden prognostik faktörlerin belirlenmesi hedeflenmiştir.
Gereç ve Yöntem: Bu retrospektif çalışmada 2017-2020 yılları arasında tersiyer merkezimizde ektopik gebelik tanısı ile hospitalize edilmiş ve ardışık çoklu doz metotreksat tedavi protokolü uygulanmış 63 hastanın klinik, labaratuvar ve demografik verileri analiz edilmiştir.
Bulgular: Hastaların 45’inde medikal tedavi ile başarılı olunmuştur. Metotreksat protokolü ile başarısız olunan hastaların %88.8’inde (n=16) takip sırasında tubal rüptür nedeni ile cerrahi operasyon ihtiyacı gelişmiştir. Medikal tedavi ile başarılı olunan grupta başvuru anında Douglas’ta serbest mayi ortalaması 2.40±0.70 mm (Ort.±SH); başarısız olunan grupta 10.38±3.05 mm (Ort.±SH) bulunmuştur. Medikal tedavi ile başarılı olunan grubun başvuru β-hCG düzeyi 3668.55±440.55 IU/L (Ort.±SH); başarısız olunan grubunki 4929.72±752.65 IU/L (Ort.±SH) bulunmuştur.
Sonuç: Ardışık çoklu doz metotreksat protokolünün başarı oranı %71.4 olarak saptanmıştır. Medikal tedavi ile başarısız olunan grupta başlangıç serum β-hCG düzeyinin yüksek olduğu, yine ilk başvuruda Douglas’ta sonografik olarak ölçülen serbest sıvı miktarının yüksek olduğu tespit edilmiştir.

Keywords

Metotreksat, Dış Gebelik, Tubal Rüptür

Analysis of multiple-dose methotrexate therapy in tubal ectopic pregnancies

Abstract

Purpose: The study aimed at determining the success rate of sequential multi-dose methotrexate treatment in tubal ectopic pregnancy (EP) patients and the prognostic factors affecting the treatment success.
Materials and Methods: Clinical, laboratory, and demographic data of 63 patients -hospitalized with the diagnosis of EP in our tertiary center between 2017-2020 and administered sequential multiple-dose methotrexate treatment protocol- were analyzed in this retrospective study.
Results: Based on research findings, medical treatment was successful in 45 of the patients. It was found that 16 out of 18-patient, 88.8% of the patients in the failed group with methotrexate treatment, were operated on due to tubal rupture during follow-up. The mean of sonographic free fluid in Douglas of the successful group with methotrexate treatment was found to be 2.40±0.70 mm (Mean±SE), while it was 10.38±3.05 mm (Mean±SE) in the failed group at the first consultation. The initial β-hCG value of the successful group with methotrexate treatment was measured 3668.55±440.55 IU/L (Mean±SE), while it was 4929.72±752.65 IU/L (Mean±SE) in the failed group.
Conclusion: The success rate of the sequential multiple dose methotrexate protocol was 71.4%. Both the initial serum β-hCG level and the amount of sonographic free fluid in the pouch of Douglas were found high in the failed group with medical treatment at the first consultation.

Keywords

Methotrexate, Ectopic Pregnancy, Tubal Rupture

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