Ektopik Gebelik Olgularında Tedavi Yaklaşımları

Abstract

Treatment Management in Ectopic Pregnancy The incidence of ectopic pregnancy has increased in the recent years and it has been the most important cause of maternal mortality and morbidity in the first trimester. The management of ectopic pregnancy changes regarding the factors such as, the hemodynamic stability of the patient at the initial diagnosis, desire to maintain fertility and the degree of the tubal injury. In our study, 68 patients diagnosed with ectopic pregnancy in the last five years in Gynecology and Obstetrics Department of Ondokuz Mayis University, Faculty of Medicine were retrospectively examined. The ratios of operative as well as nonoperative methods applied to the patients, the success rates and the factors affecting the achievement were evaluated. A total of 57 patients were operated and 11 patients had non operative treatment. It was concluded that ectopic pregnancy should be frequently considered in the early and differential diagnosis to decrease the morbidity and cost rates as well as to increase the perce ntage of nonoperative management. Ektopik gebelik, görülme sıklığı son yıllarda artmakta olup, maternal mortalite ve morbidi-tenin ilk trimesterde en önemli nedeni olmaya devam etmektedir. Ektopik gebelik olguların-daki tedavi yaklaşımı, tanı anındaki hastanın hemodinamik stabilitesi, fertilite arzusu, tubal hasar düzeyi gibi faktörlere bağlı olarak değişiklik göstermektedir. Çalışmamızda, son beş yılda Ondokuz Mayıs Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği'nde ektopik gebelik tanısı konulan 68 hasta retrospektif olarak incelendi. Hastalara uygulanan operatif ve nonoperatif tedavi yöntemlerinin oranları, başarı yüzdeleri ve başarıyı etkileyen faktörler değerlendirildi. Toplam 57 hastada cerrahi yaklaşım, 11 hastada ise nonoperatif tedavi uygulandı. Maliyet ve morbidite oranlarının azaltılması, nonoperatif tedavi yüzdelerinin arttırılması için erken tanı ve ön tanılar arasında ektopik gebeliğin daha sık düşünülmesi gerektiği sonucuna varıldı.

Keywords

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References

1. Malatyalıoğlu E. Ektopik Gebelik. Beksaç S. (ed.) O b stetrik Maternal Fetal Tıp ve Perinatoloji, 1.baskı. İstanbul, Medical Network, 2001; 1086–1113.
2. Stovall TG, McCord ML. Early pregnancy lost and e c t o p i c pregnancy. In: Berek JS, Adashi EY, Hillard PA (eds). Novak’s Gynecology (12th ed). Maylard, W i lliams&Wilkins, 1996; 487–423.
3. Cunningham FG, MacDonald, Clark SL et al. W i l l i a m s Obstetrics ( 20th ed). New Jersey, Prentice- Hall International, Inc. 1997; 607–634.
4. Nguyen PKP, Wallach EE. Contemporary diagnosis and management of ectopic pregnancy. Clinical O b s t e t r i c s and Gynecology 1997; 17: 1–5.
5. Leon Speroff, Marc AF. Ectopic Pregnancy. in: Clinical Gynecologic Endocrinology and Infertility (7th ed). Lippicott Williams&Wilkins, 2005; 1275–1302.
6. Bren JL. A 21 year survey of 654 ectopic pregnancies. Am J Obstet Gynecol 1970; 106: 1004–1019.
7. Bouyer J, Coste J, Fernandez H, et al. Sides of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002; 17: 3224–3230.
8. Garcia AJ, Aubert JM, Sama J. Expectant management of presumed ectopic pregnancies. Fertil Steril 1987; 48: 395–400.

9. Lostalo P, Cacciatore B, Sjoberg J. Expectant management of ectopic pregnancy. Obstet Gynecol 1992; 80: 345–348.
10. Shalev E, Peleg D, Tsabari A, et al. Spontaneous resolution of ectopic tubal pregnancy: natural h i s t o r y . Fertil Steril 1995; 63: 15–9.
11. Trio D, Strobelt N, Picciolo C et al. Prognostic factors for successful expectant management of ectopic p r e g n a n c y . Fertil Steril 1995; 63: 469–472.
12. Stoval T, Ling F. Some new approaches to ectopic pregnancy. Contemp Obstet Gynecol 1992; 37: 32–68. 13. Gamzu R, Almog B, Levin Y, et al., Efficacy of m e t h o t r e x a t e treatment in extra uterine pregnancies defined by stable or increasing human chronic g o n a d o t r o p i n concentrations. Fertil Steril 2002; 77: 761–765.
13. Makinen JI, Kivijarvi AK, Irjala KM. Success of non- s u r g i c a l management of ectopic pregnancy. Lancet 1990; 335: 1099–1100.
14. Kumtepe Y, Kadanali S. Medical treatment of ruptured with hemodynamically stable and unruptured ectopic pregnancy patients. European Journal of Obstetrics
15. & Gynecology and Reproductive Biology 2004; 116: 221–225.
16. Stovall TG, Ling FW Single-dose methotrexate: An
17. Expanted Clinical Trial. Am J Obstet Gynecol 1994; 170: 1840–1841.
18. Pisarska MD, Carson SA, Buster JE, Ectopic
19. P r e g n a n c y . Lancet 1998; 351: 1115–1120.
20. Erdem M, Erdem A, Arslan M, et al. Single-dose methotrexate for the treatment of unruptured ectopic pregnancy. Arch Gynecol Obstet. 2004; 270: 201–204.
21. Jeffcoate TN. Salpingectomy or salpingoophorectomy. J Obstet Gynaecol Br Emp. 1955; 62: 214–215.
22. Ory SJ, Nnadi E, Herrmann R, et al. Fertility after e c t o p i c pregnancy. Fertil Steril 1993; 60: 231–235.