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Assesment Of Diagnosis And Clinical Approach In Ectopic Pregnancies With Analysis Of Ectopic Pregnancy Cases

Year 2016, Volume: 13 Issue: 3, 121 - 124, 01.07.2016

Abstract

Aim: The totalitarian view of data of ectopic pregnancy cases will help practitioners to examine the treatment modalities dynamicaly and to exhibit appropriate management for patients by increasing the awareness and knowledge of professionals about the subject which will support the reduction in morbidity and mortality.Material And Methods: A total of 100 ectopic pregnancy cases managed at Ankara Education and Research Hospital were retrospectively analysed. Age, contraceptive method and previous abdominal surgery, smoking, obstetric history, symptoms, serum B-hCG levels, ultrasonographic findings, localization of ectopic pregnancy, management modalities were drawn from medical records.Results: Ectopic pregnancies were localized at tuba in 95% of cases, at ovarıum in 5% of cases. The rates of previous abdominal surgery, amenorea and previous ectopic pregnancy were 28%, 54% and 5%, respectively. Intrauterine device usage was in 21% of the cases and tubal ligation was present in 4%. βHcg values were over 2500 IU/l in 32% of cases and below 500 IU/l in 26% of cases. Adnexial mass size were between 0-25 mm in 45% of patients, between 25-40 mm in 41% of cases and greater than 40mm in 14% of cases. Abdominal pain and vaginal bleeding were in 39% and 30% of the cases. Patients free of symptoms were 4%. Related to the treatment modalities, rates of laparatomy, laparascopy, methotrexate administration and expectant management were %52, %20, %25 and %3, respectively.

References

  • Camran Nezhat, Farr Nezhat, Ceana Nezhat. Management of the Ectopic Pregnancy, Nezhat’s Operative Gynecologic Laparoscopy with Histeros- copy 2008.
  • John wiley and sons, Ltd.Interventions for tubal ectopic pregnancy. The cochrane collaboration 2009.
  • Bouyer J, Coste J, Fernandez H et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002;17:3224- 3230.
  • Alkatout I, Honemeyer U, Strauss A,et al. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 2013;68:571.
  • Anderson FW, Hogan JG, Ansbacher R. Sudden death: ectopic pregnan- cy mortality. Obstet Gynaecol Br Emp 1955;62:70.
  • Tulandi T. Current protocol for ectopic pregnancy. Contemp Obstet Gyne- col 1999; 44:42.
  • Alsuleiman SA, Grimes EM. Ectopic pregnancy: a review of 147 cases. J Reprod Med. 1982;27:101.
  • Job-Spira N, Fernandez H, Bouyer J, Pouly JL, Germain E, Coste J. Rup- tured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France. Am J Obstet Gynecol. 1999;180:938.
  • Backman T, Rauramo I, Huhtala S, Koskenvuo M. Pregnancy during the use of levonorgestrel intrauterine system. Am J Obstet Gynecol 2004;190:50.
  • Tulandi T,Sammour A. Evidence –based management of ectopic preg- nancy. Curr Opin Obstet Gynecol.2000;12 :289-292.
  • Sowter MC, Farquhar CM. Ectopic pregnancy:an update. Curr Opin Obs- tet Gynecol.2004;16:289-293.
  • Donald L.Fylstra,MD. Ectopic pregnancy after hysterectomy:a review and insight into etiology and prevention. Fertility and Sterility2010: 94 :431- 435.
  • Isaac Jr JD, Cesare Sr CD,Cowan BD. Ectopic pregnancy following hys- terectomy:an update for the1990s. Obstet Gynecol 1996;88:732.
  • Silva C, Sammel MD, Zhou L, Gracia C, Hummel AC, Barnhart K. Human chorionic gonadotropin profile for women with ectopic pregnancy. Obstet Gynecol. 2006;107:605.
  • Atri M,Leduc C ,Gillett P,et Al. Role of endovaginal sonography in the diagnosis and management of ectopic pregnancy. Radiographics 1996;16:755.
  • Dialani V,Levine D. Ectopic pregnancy:a review. Ultrasound Q 2004;20:105.
  • Mohammed Agdi,MD,Togas Tulandi,MD. Surgical treatment of ectopic pregnancy. Best Practice and Research Clinical Obstetrics and Gynaeco- logy 2009; 23:519-527.
  • 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;105:1052.
  • Yao M ve Tulandi T. Current status of surgical and nonsurgical manage- ment of ectopic pregnancy. Fertil Steril 1997;67:421-433.
  • Canis M,Savary D,Pouly JL et al. Ectopic pregnancy :criteria to decide between medical and concervative surgical treatment?. J Gynecol Obstet Biol Reprod (Paris)2003;32:S54-S63.
  • Shalev ,Peleg D,Tsabari A ET AL. Spontaneous resolution of ectopic tubal pregnancy: natural history. Fertil Steril 1995;63:15-19.
  • Ankum WM, Van der Veen F, Hamerlynck JVThH,Lammes FB. Laparos- copy; A dispensable tool in the diagnosis of ectopic pregnancy?. Human Reproduction 1993;8:1301–6.
  • Mol BWJ, Hajenius PJ, Engelsbel S, Ankum WM, Vander Veen F, Hemrika DJ, et al. Serum human chorionic gonadotropin measurement in the di- agnosis of ectopic pregnancy when transvaginal sonography is inconc- lusive. Fertility&Sterility1998;70:972-981..

Ektopik Gebelik Olgularının Analizi İle Ektopik Gebeliklerde Tanı ve Yaklaşımın Değerlendirilmesi

Year 2016, Volume: 13 Issue: 3, 121 - 124, 01.07.2016

Abstract

Amaç: Amacımız ektopik gebelik vakalarımızın verilerine bütüncül bir bakış ile hekimlerimizin konu ile ilgili farkındalığının ve bilgilerinin artmasına yardımcı olarak tedavi modalitelerini dinamik bir şekilde gözden geçirmelerine, hastaya uygun yaklaşımı sergileyerek mortalite ve morbiditenin azalmasına destek vermektir.Gereç ve Yöntemler: 2 yıllık süre içerisinde Ankara Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum kliniğinde ektopik gebelik tanısı ile yönetimi yapılan toplam 100 hasta retrospektif olarak analiz edildi. Yaş, kontraseptif metod, daha önceki batın cerrahisi, sigara kullanımı, obstetrik hikaye, semptomlar, serum β-Hcg seviyesi, ultrasonografi bulguları, ektopik gebeliğin yerleşimi, yaklaşım modalitileri medikal kayıtlardan çıkarıldı. Hastalar tedavi modalitelerine göre laparatomi, laparaskopik cerrahi ve metotreksat tedavisi olmak üzere 3 gruba ayrıldı.Sonuç: Vakalarımızın % 95’inde ektopik gebelik tubada, % 5’inde overde yerleşmiş idi. Hastaların %28 inde geçirilmiş batın cerrahisi, % 54 ünde amenore, % 5 inde geçirilmiş ektopik gebelik hikayesi mevcut idi. Ektopik gebelik vakalarının %21’ i rahim içi araç, % 4’ ü tüp ligasyonu ile korunuyordu. Vakaların % 32’si 2500 IU/l üzeri B-Hcg değerine sahip iken, % 26’ sı 500 IU/l’nin altında β-Hcg degerine sahipti. Ultrasonda adnexial kitle izlenen hastaların % 45’indeki kitle boyutu 0-25mm arasında ,% 41’indeki kitle boyutu 25-40mm,% 14 ‘ündeki kitle boyutu 40mm üstünde idi. Hastaların öncelikli şikayeti % 39’unda yalnız abdominal ağrı, %30’unda yalnız vajinal kanama, % 27’ sinde abdominal agrı ve vajinal kanama bir arada, %4’ ünde aktif şikayet yoktu. Hastaların yönetimi % 52’sinde laparatomi, % 20’sinde laparaskopi, % 25’inde ise yalnız methotrexate, % 3 hastada klinik izlem ile yapıldı.

References

  • Camran Nezhat, Farr Nezhat, Ceana Nezhat. Management of the Ectopic Pregnancy, Nezhat’s Operative Gynecologic Laparoscopy with Histeros- copy 2008.
  • John wiley and sons, Ltd.Interventions for tubal ectopic pregnancy. The cochrane collaboration 2009.
  • Bouyer J, Coste J, Fernandez H et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002;17:3224- 3230.
  • Alkatout I, Honemeyer U, Strauss A,et al. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 2013;68:571.
  • Anderson FW, Hogan JG, Ansbacher R. Sudden death: ectopic pregnan- cy mortality. Obstet Gynaecol Br Emp 1955;62:70.
  • Tulandi T. Current protocol for ectopic pregnancy. Contemp Obstet Gyne- col 1999; 44:42.
  • Alsuleiman SA, Grimes EM. Ectopic pregnancy: a review of 147 cases. J Reprod Med. 1982;27:101.
  • Job-Spira N, Fernandez H, Bouyer J, Pouly JL, Germain E, Coste J. Rup- tured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France. Am J Obstet Gynecol. 1999;180:938.
  • Backman T, Rauramo I, Huhtala S, Koskenvuo M. Pregnancy during the use of levonorgestrel intrauterine system. Am J Obstet Gynecol 2004;190:50.
  • Tulandi T,Sammour A. Evidence –based management of ectopic preg- nancy. Curr Opin Obstet Gynecol.2000;12 :289-292.
  • Sowter MC, Farquhar CM. Ectopic pregnancy:an update. Curr Opin Obs- tet Gynecol.2004;16:289-293.
  • Donald L.Fylstra,MD. Ectopic pregnancy after hysterectomy:a review and insight into etiology and prevention. Fertility and Sterility2010: 94 :431- 435.
  • Isaac Jr JD, Cesare Sr CD,Cowan BD. Ectopic pregnancy following hys- terectomy:an update for the1990s. Obstet Gynecol 1996;88:732.
  • Silva C, Sammel MD, Zhou L, Gracia C, Hummel AC, Barnhart K. Human chorionic gonadotropin profile for women with ectopic pregnancy. Obstet Gynecol. 2006;107:605.
  • Atri M,Leduc C ,Gillett P,et Al. Role of endovaginal sonography in the diagnosis and management of ectopic pregnancy. Radiographics 1996;16:755.
  • Dialani V,Levine D. Ectopic pregnancy:a review. Ultrasound Q 2004;20:105.
  • Mohammed Agdi,MD,Togas Tulandi,MD. Surgical treatment of ectopic pregnancy. Best Practice and Research Clinical Obstetrics and Gynaeco- logy 2009; 23:519-527.
  • 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;105:1052.
  • Yao M ve Tulandi T. Current status of surgical and nonsurgical manage- ment of ectopic pregnancy. Fertil Steril 1997;67:421-433.
  • Canis M,Savary D,Pouly JL et al. Ectopic pregnancy :criteria to decide between medical and concervative surgical treatment?. J Gynecol Obstet Biol Reprod (Paris)2003;32:S54-S63.
  • Shalev ,Peleg D,Tsabari A ET AL. Spontaneous resolution of ectopic tubal pregnancy: natural history. Fertil Steril 1995;63:15-19.
  • Ankum WM, Van der Veen F, Hamerlynck JVThH,Lammes FB. Laparos- copy; A dispensable tool in the diagnosis of ectopic pregnancy?. Human Reproduction 1993;8:1301–6.
  • Mol BWJ, Hajenius PJ, Engelsbel S, Ankum WM, Vander Veen F, Hemrika DJ, et al. Serum human chorionic gonadotropin measurement in the di- agnosis of ectopic pregnancy when transvaginal sonography is inconc- lusive. Fertility&Sterility1998;70:972-981..
There are 23 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Şule Özel

Gülenay Gençosmanoğlu Türkmen This is me

Selim Koncagül This is me

Yusuf Ergün This is me

Publication Date July 1, 2016
Published in Issue Year 2016 Volume: 13 Issue: 3

Cite

Vancouver Özel Ş, Gençosmanoğlu Türkmen G, Koncagül S, Ergün Y. Ektopik Gebelik Olgularının Analizi İle Ektopik Gebeliklerde Tanı ve Yaklaşımın Değerlendirilmesi. JGON. 2016;13(3):121-4.