Ectopic pregnancy: Review of 225 cases

Öz

Objective: To evaluate preoperative and postoperative characteristics of the patients who had undergone laparoscopy or laparotomy with diagnosis of ectopic pregnancy in Zeynep Kamil Children and Women's Hospital between 1997 and 2002. Material and methods: The medical files of 225 patients who had undergone surgical procedure with diagnosis of ectopic pregnancy were reviewed retrospectively. Mean age, mean gravidity, mean parity, mean preoperative and postoperative B hCG, hemoglobine levels, complication rates, confirmity rates of ultrasonografic and curettage findings, mean operative times, mean preoperative and postoperative observation times, intraabdominal haemorrhage amounts were evaluated. Results: 79 (%35.1) of the 225 patients had undergone laparoscopy, the remaining 146 patients (%64.9) had undergone laparotomy. There were not any significant differences in mean age, mean gravidity, mean parity, mean sistolic and diastolic blood pressures, mean pulse rate, mean preoperative and postoperative $\beta$hCG levels, complication rates, confirmity rates of ultrasonografic and curettage findings with ectopic pregnancy between two groups (p>0.05). Mean postoperative hemoglobine levels (p

Anahtar Kelimeler

• Retrospective Studies,Pregnancy, Ectopic,Laparotomy,Laparoscopy,Postoperative Complications

Ektopik gebelik: 225 olgunun incelenmesi

Öz

Amaç: 1997-2002 tarihleri arasında Zeynep kamil Kadın ve Çocuk Hastalıkları Hastanesi'nde ektopik gebelik tanısı alıp laparoskopi ve laparotomi uygulanmış olguların operasyon öncesi ve sonrası bulgularını değerlendirmek. Geraç ve Yöntem: Ektopik gebelik tanısı ile opere edilmiş 225 hastanın medikal kayıtları retrospektif olarak incelendi. Ortalama $\beta$ yaş, gravida, parite, preoperatif ve postoperatif hCG, hemoglobin seviyeleri, komplikasyon oranları, ultrasonografi ve küretaj bulgularının doğruluk oranları, operasyon süreleri, preoperatif ve postoperatif gözlem süreleri, batın içi kanama miktarları değerlendirildi. Bulgular: İncelenen 225 olgunun 79'u (%35.1) aparoskopi, 146'sı (%64.9) ise laparotomi ile tedavi edildi. Laparoskopi ve laparotomi grupları arasında ortalama yaş, gravida, parite, sistolik ve diyastolik kan basıncı, nabız dakika sayısı, operasyon öncesi ve sonrası ortalama â-hCG değerleri, komplikasyon oranları, ultrasonografi ve küretaj bulgularının doğruluk oranları açısından farklılık izlenmedi (p>0.05). Ortalama postoperatif hemoglobin miktarı (p

Anahtar Kelimeler

• Geriyedönük çalışma,Gebelik, ektopik,Laparotomi,Laparoskopi,Ameliyat sonrası komplikasyonlar

Kaynakça

1. Aboud E, Chaliha C. Nine year survey of 138 ectopic pregnancies. Arch Gynecol Obstet 1998; 261: 83-87
2. Cunnigham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GV et al. Ectopic pregnancy. In: Cunnigham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GV, Clark SL, eds. Williams Obstetrics, 20th ed
3. Connecticut: Appleton&Lange, 1997: 607-634
4. Makinen JI. Ectopic pregnancy in Finland 1967-1983: a massive increase. Br Med J 1987; 294: 740-741
5. Ploman L, Wicksell F. Fertility after conservative surgery in tubal pregnancy. Ada Obstet Gynecol Scand 1960; 39: 143-52
6. Schenker JG, Eyal F, Polishuk WZ. Fertility after tubal pregnancy. Surg Gynecol Obstet 1972; 135: 74-6
7. Rock JA, Damario MA. Ectopic pregnancy. In: Rock JA, Thomson JD., eds. Te Ldnde's Operative Gynecology, 8th ed. Philadelphia: Lippincott-Raven, 1997:501-527
8. Cacciatore B. Can the status of tubal pregnancy be predicted with transvaginal sonography?. A prospective comparison of sonographic, surgical, and serum hCG findings.Radiology 1990; 177: 481-84

9. Atri M, Bret PM, Tulandi T. Spontaneous resolution of ectopic pregnancy: initial appearance and evolution at transvaginal US. Radiology 1993; 186: 83-86
10. Vermesh M, Suva PD, Rosen GF, Stein AL, Fossum GT, Sauer MV. Management of unruptured ectopic gestation by linear salpingostomy: A prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol 1989; 73: 400-404
11. Yao M, Tulandi T. Surgical and medical management of tubal and non-tubal ectopic pregnancies. Curr opin Obstet Gynecol 1998; 10:371-374
12. Soriano D, Yefet Y, Oelsner G, Goldenberg M, Mashiach S, Seidman DS. Operative laparoscopy for management of ectopic pregnancy in patients with hypovolemic shock. J Am Assoc Gynecol Laparosc 1997; 4: 363-367
13. Bouyer J, Job-Spira N, Pouly L, Coste J, Germain E, Fernandez H. Fertility following radical, conservative-surgical or medical treatment for tubal pregnancy: a population-based study
14. Br J Obstet Gynaecol 2000; 107: 714-721
15. Lundorff P, Thorburn J, Hahlin M, Kallfelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy: A randomized trial versus laparotomy
16. Acta Obstet Gynecol Scand 1991; 70:343-48
17. Akhan SE, Baysal B.Laparatomy or Laparoscopic surgery? Factors affecting the surgeons choice for the treatment of ectopic pregnancy. Arch Gynecol Obstet 2002; 266: 79-82
18. Thornton KL, Diamond MP, DeCherney AH
19. Linear salpingostomy for ectopic pregnancy
20. Obstet Gynecol Clin North Am 1991; 81: 95- 109
21. Foulk RA, Steiger RM. Operative management of ectopic pregnancy: A cost analysis. Am J Obstet Gynecol 1996; 175: 90-96
22. Seifer DB, Gutmann JN, Grant WD, Kamps CA, DeCherney AH. Comparison of persistent ectopic pregnancy after laparoscopic salpin­ gostomy versus salpingostomy at laparotomy for ectopic pregnancy. Obstet Gynecol 1993; 81: 378-82.