Epidemiologic Analysis of Patients Who Were Diagnosed As Ectopic Pregnancy In Our Clinic Between January 2008 and March 2011
Öz
Aim: To evaluate risk factors, diagnosis and treatment procedures in women admitted to our clinic with ectopic pregnancy. Materials and Methods: A total of 75 women who were diagnosed as having an ectopic pregnancy at the Taksim Educationand Research Hospital between January 2008 and March 2011 were included in this study. All data were analyzed retrospectively. Age, complains, β-HCG levels, transvaginal ultrasound findings, fetal cardiac activity, last menstrual date, risk factors, contraception method and treatment procedures were evaluated.Results: The mean age of the patients was 30,4 ± 5,9 years. Thirty patients 40% applied with pain, ten 13% with a delay of menstrual bleeding and 35 47% with vaginal hemorrhage. Mean gestational age at the time of diagnosis was 5 ± 1,7 weeks and mean β-HCG level was 4338 ± 6341,5 mIU/ml. With transvaginal ultrasonography, ectopic focii were detected in 55 patients 73% and the mean lesion size was 36,6 ± 16,2 mm. Fetal cardiac activity within the ectopic pregnancy was observed in 18 patients 32% . Distribution of contraception methods was; condoms in five cases 6,6% , oral contraceptive in three cases %4 , intrauterin devices in 14 cases 18,7% and no contraception method in 53 patients. Four patients had previous surgery for ectopic pregnancy, seven patients had cesarean section, one patient was previously operated on an adnexal mass, one patient had myomectomy, three patients had appendectomy and one patient had bowel operation. Surgery for ectopic pregnancy was performed in 49 patients 65,3% , medical treatment was performed in eight patients 10,7% and expectant management was performed in 18 patients 24% . Medical management was unsuccessful in one patient and surgery was performed. All patients were treated successfully and no mortality was observed.Conclusion: In our study vaginal hemorrhage 47% was the most common complaint, recent abdominal surgery was the most important risk factor 22,7% , intrauterin device was the most common contraception method 18,7% and surgery was the most common treatment method 65,3% . We conclude that the mortality of ectopic pregnancy can be reduced with early diagnosis and treatment
Anahtar Kelimeler
Kaynakça
- Farquhar CM. Ectopic pregnancy. Lancet 2005; 366: 583- 91.
- Buckley RG, King KJ, Disney JD, Gorman JD, et al. History and physical examination to estimate the risk of ectopic pregnancy: Validation of a clinical prediction model. Ann Emerg Med 1999;34:589-94. Comment in Ann Emerg Med 1999;34:664-7.
- Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med 1999;33:283-90.
- Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for ectopic pregnancy — United States, 1970–1989. MMWR CDC Surveill Summ 1993;42:73-85.
- Thonneau P, Hijazi Y, Goyaux N, Calvez T, Keita N. Ectopic pregnancy in Conakry, Guinea. Bull World Health Organ 2002; 80: 365- 70.
- Goktolga U. Ektopik Gebelik. Turkiye Klinikleri J Surg Med Sci 2006; 2: 6- 12.
- Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ 2005; 173: 905- 12.
- 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;101:778-84.
- Musa J, Daru PH, Mutihir JT, Ujah IA. Ectopic pregnancy in Jos Northern Nigeria: prevalence and impact on subsequent fertility. Niger J Med 2009; 18: 35- 8.
- Condous G. Ectopic pregnancy--risk factors and diagnosis. Aust Fam Physician 2006; 35: 854- 7.
- Stovall TG, McCord ML. Early pregnancy lost and ectopic pregnancy. In: Berek JS, Adashi EY, Hillard PA (eds). Novak’s Gynecology (12th ed). Maylard, Williams&Wilkins, 1996; 487–423.
- Alsuleiman SA, Grimes EM. Ectopic pregnancy. A review of 147 cases. J Reprod Med 1982; 27: 101- 6.
- Doyle MB, DeCherney AH, Diamond MP. Epidemiology and etiology of ectopic pregnancy. Obstet Gynecol Clin North Am 1991; 18: 1- 17.
- Pradhan P, Thapamagar SB, Maskey S. A profile of ectopic pregnancy at nepal medical college teaching hospital. Nepal Med Coll J 2006; 8: 238- 42.
- Şahin HG, Zeteroğlu Ş, Sürücü R, Sucaklı H, Kamacı M. Ektopik gebeliklerde risk faktörleri ve tanı yöntemlerinin değerlendirilmesi. Klinik Bilimler & Doktor 2004; 10: 696-700.
- Coste J, Job-Spira N, Aublet-Cuvelier B, Germain E, Glowaczower E, Fernandez H, Pouly JL: Incidence of ectopic pregnancy. First results of a population-based register in France. Hum Reprod. 9:742-745,1994.
- Gamzu R, Almog B, Levin Y, et al., Efficacy of methotrexate treatment in extra uterine pregnancies defined by stable or increasing human chronic gonadotropin concentrations. Fertil Steril 2002; 77: 761–765.
- Makinen JI, Kivijarvi AK, Irjala KM. Success of nonsurgical management of ectopic pregnancy. Lancet 1990; 335: 1099–1100.
- Gamzu R, Almog B, Levin Y, Avni A, Jaffa A, Lessing JB, et al. Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic gonadotropin concentrations. Fertil Steril 2002; 77: 761- 5.
- Cooray H, Harilall M, Farquhar CM. A six-year audit of the management of ectopic pregnancy. Aust N Z J Obstet Gynaecol 2002; 42: 538- 42.
Kliniğimizde Ocak 2008 ve Mart 2011 Tarihleri Arasında Ektopik Gebelik Tanısı Almış Vakaların İrdelenmesi
Öz
Amaç: Kliniğimize ektopik gebelik tanısıyla interne ettiğimiz olguların risk faktörleri, tanı yöntemleri ve tedavi seçenekleri açısından retrospektif olarak değerlendirilmesi. Gereç ve Yöntem: Çalışmaya Ocak 2008- Mart 2011 tarihleri arasında Taksim Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde ektopik gebelik tanısı koyulan 75 hasta alındı. Hasta dosyaları retrospektif olarak incelendi. Hastaların yaşları, şikayetleri, β-HCG değerleri, transvajinal ultrasonografi ile odak varlığı, büyüklüğü, fetal kalp aktivitesinin varlığı, son adet tarihleri, risk faktörleri, korunma yöntemleri ve uygulanan tedavi yöntemleri kaydedildi.Bulgular: Hastaların yaş ortalaması 30,4±5,9 yıl idi. 30 hasta %40 ağrı, 10 hasta %13 adet rötarı ve 35 hasta %47 vajinal hemoraji şikâyeti ile başvurdu. Ortalama gebelik haftası 5±1,7 hafta, ortalama β-HCG değerleri 4338 ± 6341,5 mIU/ml olarak bulundu. Yapılan transvajinal ultrasonografide 55 hastada %73 ektopik odak izlendi, odak büyüklüklerinin ortalaması ise 36,6 ±16,2 mm olarak hesaplandı. 55 olgunun 18’inde %32 ise fetal kalp aktivitesi izlendi. Kontrasepsiyon yöntemi olarak 5 olgu %6,6 kondom, 3 olgu %4 oral kontraseptif, 14 olgu %18.7 rahim içi araç kullanırken, 53 olgu %70,7 herhangi bir kontrasepsiyon yöntemi kullanmıyordu. 4 hastanın ektopik gebelik, 7 hastanın sezaryen, 1 hastanın adneksiyal kitle, 1 hastanın myomektomi, 3 hastanın appendektomi, 1 hastanın geçirilmiş barsak operasyonu öyküsü mevcuttu. Tedavi yaklaşımlarına bakılacak olursa, 18 hastaya %24 ekspektan yaklaşım, 8 hastaya %10,7 medikal tedavi ve 49 hastaya %65,3 cerrahi tedavi uygulandı. 1 hastaya ise medikal tedavinin başarısız olması üzerine cerrahi tedavi uygulandı. Bütün hastalar şifa ile taburcu edildi, mortalite gözlenmedi. Sonuç: Çalışmamızda en sık başvuru şikayeti vajinal hemoraji %47 , en sık risk faktörü geçirilmiş batın cerrahisi %22,7 , en sık kontrasepsiyon yöntemi rahim içi araç %18,7 , en sık tedavi yöntemi ise cerrahi tedavi %65,3 olarak bulundu. Bu epidemiyolojik çalışmanın verileri ışığında erken gebelikte en sık mortalite sebebi olan ektopik gebeliğin erken teşhis ve tedavi yöntemleri uygulanarak mortalitesinin azaltılabileceği vurgulanmıştır
Anahtar Kelimeler
Kaynakça
- Farquhar CM. Ectopic pregnancy. Lancet 2005; 366: 583- 91.
- Buckley RG, King KJ, Disney JD, Gorman JD, et al. History and physical examination to estimate the risk of ectopic pregnancy: Validation of a clinical prediction model. Ann Emerg Med 1999;34:589-94. Comment in Ann Emerg Med 1999;34:664-7.
- Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med 1999;33:283-90.
- Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for ectopic pregnancy — United States, 1970–1989. MMWR CDC Surveill Summ 1993;42:73-85.
- Thonneau P, Hijazi Y, Goyaux N, Calvez T, Keita N. Ectopic pregnancy in Conakry, Guinea. Bull World Health Organ 2002; 80: 365- 70.
- Goktolga U. Ektopik Gebelik. Turkiye Klinikleri J Surg Med Sci 2006; 2: 6- 12.
- Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ 2005; 173: 905- 12.
- 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;101:778-84.
- Musa J, Daru PH, Mutihir JT, Ujah IA. Ectopic pregnancy in Jos Northern Nigeria: prevalence and impact on subsequent fertility. Niger J Med 2009; 18: 35- 8.
- Condous G. Ectopic pregnancy--risk factors and diagnosis. Aust Fam Physician 2006; 35: 854- 7.
- Stovall TG, McCord ML. Early pregnancy lost and ectopic pregnancy. In: Berek JS, Adashi EY, Hillard PA (eds). Novak’s Gynecology (12th ed). Maylard, Williams&Wilkins, 1996; 487–423.
- Alsuleiman SA, Grimes EM. Ectopic pregnancy. A review of 147 cases. J Reprod Med 1982; 27: 101- 6.
- Doyle MB, DeCherney AH, Diamond MP. Epidemiology and etiology of ectopic pregnancy. Obstet Gynecol Clin North Am 1991; 18: 1- 17.
- Pradhan P, Thapamagar SB, Maskey S. A profile of ectopic pregnancy at nepal medical college teaching hospital. Nepal Med Coll J 2006; 8: 238- 42.
- Şahin HG, Zeteroğlu Ş, Sürücü R, Sucaklı H, Kamacı M. Ektopik gebeliklerde risk faktörleri ve tanı yöntemlerinin değerlendirilmesi. Klinik Bilimler & Doktor 2004; 10: 696-700.
- Coste J, Job-Spira N, Aublet-Cuvelier B, Germain E, Glowaczower E, Fernandez H, Pouly JL: Incidence of ectopic pregnancy. First results of a population-based register in France. Hum Reprod. 9:742-745,1994.
- Gamzu R, Almog B, Levin Y, et al., Efficacy of methotrexate treatment in extra uterine pregnancies defined by stable or increasing human chronic gonadotropin concentrations. Fertil Steril 2002; 77: 761–765.
- Makinen JI, Kivijarvi AK, Irjala KM. Success of nonsurgical management of ectopic pregnancy. Lancet 1990; 335: 1099–1100.
- Gamzu R, Almog B, Levin Y, Avni A, Jaffa A, Lessing JB, et al. Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic gonadotropin concentrations. Fertil Steril 2002; 77: 761- 5.
- Cooray H, Harilall M, Farquhar CM. A six-year audit of the management of ectopic pregnancy. Aust N Z J Obstet Gynaecol 2002; 42: 538- 42.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Mart 2012 |
| Yayımlandığı Sayı | Yıl 2012Sayı: 1 |