Araştırma Makalesi
BibTex RIS Kaynak Göster

Ektopik Gebelikte 0. ve 4. gün β-HCG Değerleri ile Metotreksat Tedavisinin Başarısı Öngörülebilir mi?

Yıl 2017, Cilt: 22 Sayı: 1, 30 - 35, 30.12.2016
https://doi.org/10.21673/anadoluklin.284474

Öz

Amaç: Ektopik gebelik uterin kavite dışında gelişen gebelikleri tanımlar ve bütün gebeliklerin yaklaşık
%2’sini oluşturur. Maternal mortalitenin %10’undan sorumludur (1). Ektopik gebeliklerin
yaklaşık %97’si tubada görülmektedir (2). Klasik triadı patognomonik olmamakla birlikte menstruasyon
gecikmesi, vajinal kanama ve tek taraflı alt kadran ağrısıdır. Medikal tedavi, cerrahi
tedavi veya bekle-gör yöntemi uygulanabilecek yaklaşımlardır. Son yıllardaki gelişmeler ektopik
gebelik tanısının daha erken aşamada konmasına ve metotreksat tedavisinin yaygınlaşmasına
neden olmuştur. Bu retrospektif çalışmada tek doz metotreksat (MTX) tedavisi uygulanan 71
ektopik gebelik olgusunda başarı oranlarımızı, erken dönem β-HCG değişikliklerini ve bunların
tedavinin başarısı üzerindeki etkilerini araştırmayı amaçladık.

Gereç ve Yöntemler: Çalışmada ektopik gebelik tanısı ile yatırılan ve tek doz MTX tedavisi uygulanan
71 hasta retrospektif olarak değerlendirildi. Hastaların 0., 4. ve 7. gün β-HCG değerleri
incelendi. Tedavinin başarılı ve başarısız olduğu gruplar yaş, geçmiş ektopik gebelik öyküsü,
geçirilmiş abdominal cerrahi öyküsü, sigara kullanımı, tanı sırasında pelvik kitle, serbest sıvı ve
pozitif fetal kardiyak aktivite varlığı açısından karşılaştırıldı. Her grup için 0. ve 4. gün β-HCG
değerlerinde artış ve düşüş gösteren hasta yüzdeleri belirlendi. Dördüncü gün β-HCG değerlerinde
artış saptanan hastalarda ΔHCG (fark değişkeni) 4. gün β-HCG değeri – 0. gün β-HCG
değeri biçiminde hesaplanarak tedavinin başarılı olduğu ve başarısızlıkla sonuçlandığı gruplar
karşılaştırıldı.

Bulgular: Tek doz MTX tedavisinin başarı oranı %66,2 olarak belirlendi. Başarısız tedavi grubunda
0. ve 4. gün β-HCG değerleri anlamlı olarak daha yüksekti (p=0,018). Tedavinin başarılı
olduğu grupta hastaların %38,7’sinde, başarısızlık ile sonuçlandığı grupta ise %35,3’ünde 4. gün
β-HCG değerlerinde artış saptandı. Başarısız tedavi grubunda ΔHCG ortalama ve medyan de-
ğerleri daha yüksek tespit edilse de fark istatistiksel olarak anlamlı bulunmadı (p= 0,58).

Tartışma ve Sonuç: Tek doz MTX tedavisinin başarısı konusunda; yüksek bazal β-HCG değerlerinin
yanı sıra 4. gün β-HCG değerlerinde artış gözlenen hastalar için yüksek ΔHCG değeri ile
de başarısızlık öngörülebilir

Kaynakça

  • 1. Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005; 72(9):1707–14.
  • 2. Chang J, Elem-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance: United States, 1991–1999. MMWR. 2003;52(SS02):1–8.
  • 3. Gibbs R, Karlan B, Haney A. Danforth’s Obstetrics and Gynecology. Baltimore: Lippincott Williams and Wilkins; 2010.
  • 4. Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007;(1):CD000324.
  • 5. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a metanalysis comparing “single-dose” and “multidose” regimens. Obstet Gynecol. 2003;101(4):778–84.
  • 6. Gabbur N, Sherer DM, Hellmann M, Abdelmalek E, Phillip P, Abulafia O. Do serum beta-human chorionic gonadotropin levels on day 4 following MTX treatment of patients with ectopic pregnancy predict successful single dose therapy? Am J Perinatol. 2006;23(3):193–6.
  • 7. Lipscomb GH, Gomez IG, Givens VM, Meyer NL, Bran DF. Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate. Am J Obstet Gynecol. 2009;200(3):338.e1–e4.
  • 8. The Practice Committee of the American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril. 2008;90(5):206–12.
  • 9. Skubisz M, Lee J, Wallace E, Tong S. Decline in βhCG levels between days 0 and 4 after a single dose of methotrexate
  • 10. Nguyen Q, Kapitz M, Downes K, Silva C. Are early human chorionic gonadotropin levels after methotrexate therapy a predictor of response in ectopic pregnancy? Am J Obstet Gynecol. 2010;202(6):630.e1–5.
  • 11. Agostini A, Blanc K, Ronda I, Romain F, Capelle M, Blanc B. Prognostic value of human chorionic gonadotropin changes after methotrexate injection for ectopic pregnancy. Fertil Steril. 2007;88(2):504–6.
  • 12. Natale A, Busacca M, Candiani M, Gruft L, Izzo S, FelicettaI, et al. Human chorionic gonadotropin patterns after a single dose of methotrexate for ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2002;100(2): 227–30.
  • 13. Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril. 2007;87(3):481–4.
  • 14. Nowak-Markwitz E, Michalak M, Olejnik M, Spaczynski M. Cut-off value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril. 2009;92(4):1203–7.

Can β-HCG Values on day 0 and 4 in Ectopic Pregnancy Predict the Success of Methotrexate Treatment?

Yıl 2017, Cilt: 22 Sayı: 1, 30 - 35, 30.12.2016
https://doi.org/10.21673/anadoluklin.284474

Öz

Aim: Ectopic pregnancy describes the pregnancies that develop outside the uterine cavity and composes about 2% of all pregnancies. It is responsible for approximately 10% of cases of maternal mortality (1). 97% of ectopic pregnancies are seen in the tuba (2). The classic, though non-pathognomonic, triad of the condition is delay of menstruation, vaginal bleeding, and unilateral pelvic pain. Medical treatment, surgical treatment, and expectant management can be applied. In recent years our success in diagnosing ectopic pregnancies earlier has led to widespread use of methotrexate treatment. In this retrospective study, we aimed to investigate our success rate in 71 ectopic pregnancy patients who underwent single-dose methotrexate (MTX) treatment, in connection with early period of β-HCG changes and their impact on the success of the treatment.

Materials and Methods: In this retrospective study we evaluated 71 patients who had been diagnosed with ectopic pregnancy and treated with single-dose MTX treatment. We investigated the 0th, 4th, and 7th day β-HCG values of the patients. The groups in which the treatment had been successful and unsuccessful were compared in terms of age, previous ectopic pregnancy history, cigarette-smoking history, previous abdominal surgery history, and presence of pelvic mass, free liquid, and positive fetal cardiac activity during the diagnosis. The percentages of the patients whose 0th and 4th day β-HCG values showed an increase or decrease were determined in each group. In patients whose 4th day β-HCG values were seen to have increased, ΔHCG (the difference variable) was calculated as 4th day β-HCG value – 0th day β-HCG value and a comparison was made between the successful treatment and unsuccessful treatment groups.

Results: The success rate of single-dose MTX treatment was found to be 66.2%. In the group in which MTX treatment was unsuccessful, 0th and 4th day β-HCG values were statistically significantly higher (p=0.018). The 4th day β-HCG values were detected to have increased in 38.7% of patients in the successful MTX treatment group and 35.3% of patients in the unsuccessful MTX treatment group. Although the average and median ΔHCG values were detected to be higher in the unsuccessful MTX treatment group, the difference was not statistically significant (p=0.58).

Discussion and Conclusion: With respect to predicting the success of single-dose MTX treatment, high ΔHCG values, in addition to high basal β-HCG values, can also predict unsuccess in patients whose β-HCG values are observed to have increased on day 4.

Kaynakça

  • 1. Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005; 72(9):1707–14.
  • 2. Chang J, Elem-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance: United States, 1991–1999. MMWR. 2003;52(SS02):1–8.
  • 3. Gibbs R, Karlan B, Haney A. Danforth’s Obstetrics and Gynecology. Baltimore: Lippincott Williams and Wilkins; 2010.
  • 4. Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007;(1):CD000324.
  • 5. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a metanalysis comparing “single-dose” and “multidose” regimens. Obstet Gynecol. 2003;101(4):778–84.
  • 6. Gabbur N, Sherer DM, Hellmann M, Abdelmalek E, Phillip P, Abulafia O. Do serum beta-human chorionic gonadotropin levels on day 4 following MTX treatment of patients with ectopic pregnancy predict successful single dose therapy? Am J Perinatol. 2006;23(3):193–6.
  • 7. Lipscomb GH, Gomez IG, Givens VM, Meyer NL, Bran DF. Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate. Am J Obstet Gynecol. 2009;200(3):338.e1–e4.
  • 8. The Practice Committee of the American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril. 2008;90(5):206–12.
  • 9. Skubisz M, Lee J, Wallace E, Tong S. Decline in βhCG levels between days 0 and 4 after a single dose of methotrexate
  • 10. Nguyen Q, Kapitz M, Downes K, Silva C. Are early human chorionic gonadotropin levels after methotrexate therapy a predictor of response in ectopic pregnancy? Am J Obstet Gynecol. 2010;202(6):630.e1–5.
  • 11. Agostini A, Blanc K, Ronda I, Romain F, Capelle M, Blanc B. Prognostic value of human chorionic gonadotropin changes after methotrexate injection for ectopic pregnancy. Fertil Steril. 2007;88(2):504–6.
  • 12. Natale A, Busacca M, Candiani M, Gruft L, Izzo S, FelicettaI, et al. Human chorionic gonadotropin patterns after a single dose of methotrexate for ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2002;100(2): 227–30.
  • 13. Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril. 2007;87(3):481–4.
  • 14. Nowak-Markwitz E, Michalak M, Olejnik M, Spaczynski M. Cut-off value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril. 2009;92(4):1203–7.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm ORJİNAL MAKALE
Yazarlar

Nefise Tanrıdan Okcu

Ayşe Topçu Akduman

Bilge Çetinkaya Demir Bu kişi benim

Yayımlanma Tarihi 30 Aralık 2016
Kabul Tarihi 24 Kasım 2016
Yayımlandığı Sayı Yıl 2017 Cilt: 22 Sayı: 1

Kaynak Göster

Vancouver Tanrıdan Okcu N, Topçu Akduman A, Çetinkaya Demir B. Can β-HCG Values on day 0 and 4 in Ectopic Pregnancy Predict the Success of Methotrexate Treatment?. Anadolu Klin. 2016;22(1):30-5.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.