Öz
Aim. The aim of this study was to analyze retrospectively diagnosting modalities and treatment options of ectopic pregnancies in our clinic. Method. Sixty-four cases who were treated ectopic pregnancy in our clinic between January 2007-December 2012 have been evaluated retrospectively for demographic features, diagnosting modalities and treatment approaches. Results. The avarage age of the patients were 31.3 years. The risk factors in the order of frequencies were previous abdominopelvic surgery (17%), the use of intrauterine device (6.2%), previous ectopic pregnancies (6.2%) and previous pelvic inflammatory disease (2%). The most common complaint on admission were pelvic pain and amenorea (54.6%) and following that in the order of frequencies were vaginal bleeding with pain (40.6%) and only vaginal bleeding (4.6%). The serum mean βHCG level of the patients on admission to our clinic was 3496mLU/mL.Transvaginal ultrasonographic findings of ectopic pregnancy were seen 96.8% of cases. All of the patients were surgically treated in our series. Fifty-three percent of patients were treated by laparotomy, 48% were treated with laparoscopy.Surgical procedures were salpingectomy (62.5%), salpingostomy (29.7%), partial oopherectomy (3.1%) and oopherectomy(1.6%). Conclusion. Ectopic pregnancies are important health problems since they may interfere with fertility capability of the patient in her future life and may even cause maternal mortality. History, serum β-HCG level and TVUSG are important diagnosting tools. Surgery especially salpingectomy is still the most frequently performed treatment option in cases with tubal damage and hemodinamically instable patients.
Anahtar Kelimeler
Kaynakça
- Farquhar CM. Ectopic pregnancy. Lancet 2005; 366: 583-91.
- Thonneau P, Hijazi Y, Goyaux N, Calvez T, Keita N. Ectopic pregnancy in Conakry, Guinea. Bull World Health Organ 2002; 80: 365-70.
- Condous G. Ectopic pregnancy: challenging accepted management strategies. Aust N Z J Obstet Gynaecol.2009; 49: 346-51.
- Göktolga Ü. Ektopik Gebelik. Turkiye Klinikleri J Surg MedSci 2006; 2: 6
- Kirk E, Bourne T. The nonsurgical management of ectopic pregnancy. Curr Opin Obstet Gynecol 2006; 18: 587-93.
- Cagnacci A, Landi S, Volpe A. Rhythmic variation in the rate of ectopic pregnancy throughout the year. AmJ Obstet Gynecol 1999; 180: 1067-71.
- Buckley RG, King KJ, Disney JD, Gorman JD, Klausen JH. History and physical examination to estimate the risk of ectopic pregnancy: Validation of a clinical prediction model. Ann Emerg Med 1999; 34: 589-94.
- 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.
- Lundorff P, Hahlin M, Källfelt B, Thorburn J, Lindblom B. Adhesion formation after laparoscopic surgery in tubal pregnancy: A randomized trial versus laparotomy. Fertil Steril 1991; 55: 911-5.
- Lundorff P, Thorburn J, Hahlin M, Källfelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy. Acta Obstet Gynecol Scand 1991; 70: 343-8.
- Yao M, Tulandi T. Current status of surgical and nonsurgical management of ectopic pregnancy. Fertil Steril 1997; 67: 421-33.
- Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N. Risk factors for ectopic pregnancy: A comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol 2003; 157: 185-94.
- Storeide O, Veholmen M, Eide M, Bergsjİ P, Sandvei R. The incidence of ectopic pregnancy in Hordaland County, Norway 1976-1993. Acta Obstet Gynecol Scand 1997; 76: 345-9.
- Tancer ML, Delke I, Veridiano NP. A fifteen year experience with ectopic pregnancy. Surg Gynecol Obstet 1981; 152: 179-82.
- Job-Spira N, Coste J, Aublet-Cuvelier B, Germain E, Fernandez H, Bouyer J, Pouly JL. Incidence of extra-uterine pregnancy and characteristics of treated patients. First results of the auvergne registry. Presse Med 1995; 24: 351-5.
- Randic L, Haller H. Ectopic pregnancy among past IUD users. Int J Gynaecol Obstet 1992; 38: 299-304.
- Doyle MB, DeCherney AH, Diamond MP. Epidemiology and etiology of ectopic pregnancy. Obstet Gynecol Clin North Am 1991; 18: 1-17.
- Şahin HG, Zeteroğlu Ş. Sürücü R, Sucaklı MH, Kamacı M. Ektopik gebeliklerde risk faktörleri ve tanıyöntemlerinin değerlendirilmesi. Medical Network Klinik Bilimler ve Doktor. 2004; 10: 696-700.
- 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.
- Coste J, Job-Spira N, Fernandez H, Papiernik E, Spira A. Risk factors for ectopic pregnancy: A case-control study in France, with special focus on infectious factors. Am J Epidemiol 1991; 133: 839-49.
- Tharaux-Deneux C, Bouyer J, Job-Spira N, Coste J, Spira A. Risk of ectopic pregnancy and previous induced abortion. Am J Public Health 1998; 88: 401
- Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril 1996; 65: 1093-9.
- Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: A 10 year population-based study of 1800 cases. Hum Reprod 2002; 17: 3224-30.
- Alsuleiman SA, Grimes EM. Ectopic pregnancy: A review of 147 cases. J Reprod Med 1982; 27: 101-6.
- Turhan NÖ, İnegöl İ, Seçkin NC. A three-year audit of the management of ectopic pregnancy. J Turkish German Gynecol Assoc 2004; 5: 310-3.
- Agdi M, Tulandi T. Surgical treatment of ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 519-27.
- Strolego F, Rustico M, Pregazzi R. Seasonal incidence of extrauterine pregnancy. Minerva Ginecol 1995; 47: 499-502.
- Michelas S, Creatsas G, Fakas G, Kaskarelis D. Ectopic pregnancy: outcome of 152 cases. Int Surg 1980; 65: 355-8.
- 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 1994; 9: 742-5.
- Goldenberg M, Bider D, Seidman DS, Lipitz S, Mashiach S, Oelsner G. Seasonal patterns in tubal pregnancy. Gynecol Obstet Invest 1993; 35: 1495
- Römer T, Schmidt T, Negwer U, Rösel HD, Lober R. Is there a seasonal incidence of ectopic pregnancy?--A retrospective analysis. Zentralbl Gynakol 1994; 116: 628-30.
- Dubuisson JB, Morice P, Chapron C, De Gayffier A, Mouelhi T. Salpingectomy - the laparoscopic surgical choice for ectopic pregnancy. Hum Reprod 1996; 11: 1199-203.
Öz
Amaç. Kliniğimizde ektopik gebelik tanısı alan hastaların tanı yöntemleri ve tedavi seçenekleri açısından retrospektif analizlerini yapmak. Yöntem. Ocak 2007-Aralık 2012 tarihleri arasında kliniğimizde ektopik gebelik tanısı alan ve tedavisi yapılan 64 olgu demografik özelliklerine, tanısal yöntemlerine ve tedavi seçeneklerine göre değerlendirildi. Bulgular. Hastalarımızın yaş ortalaması 31,3’tür. Risk faktörleri sıklık sırasına göre abdominopelvik cerrahi öyküsü (%17), rahim içi araç (RİA) öyküsü (%6,2), geçirilmiş ektopik gebelik öyküsü (%6,2), pelvik inflamatuar hastalık öyküsü (PID) (% 2) idi. Hastaların kliniğimize en sık başvuru şikayeti pelvik ağrı ve amenore (%54,6) olup bunu takiben sırası ile, vajinal kanama ile birlikte pelvik ağrı (%40.6) ve sadece vajinal kanamaydı (%4,6). Başvuru esnasında olguların ortalama insan koryonik gonadotropin (β-HCG) değeri 3496mLU/mL olarak tespit edildi. Olguların %96,8’ine yapılan transvajinal ultrasonda (TVUSG) ektopik gebelik bulguları mevcuttu. Bütün hastalar cerrahi olarak tedavi edildi. Operasyonların %53’ü laparotomi ile, %47’si laparoskopi ile yapıldı. Yapılan ameliyatlar salpenjektomi (%62,5), salpingostomi (%29,7), parsiyel ooferektomi (%3,1) ve ooferektomi (%1,6) idi. Sonuç. Ektopik gebelikler, hastanın ilerideki hayatta fertilite yeteneğini bozması hatta maternal mortaliteye yol açabilmesi nedeniyle önemli bir sağlık sorunudur. Sunduğumuz çalışma, ektopik gebeliğin tanısında anamnez, β-HCG ve transvajinal ultrasonun önemini göstermektedir. Tedavide ise cerrahi özellikle salpenjektomi; tubal hasarlı ve hemodinamik olarak instabil olgularda en sık tercih edilen yöntem olarak öne çıkmaktadır.
Anahtar Kelimeler
Kaynakça
- Farquhar CM. Ectopic pregnancy. Lancet 2005; 366: 583-91.
- Thonneau P, Hijazi Y, Goyaux N, Calvez T, Keita N. Ectopic pregnancy in Conakry, Guinea. Bull World Health Organ 2002; 80: 365-70.
- Condous G. Ectopic pregnancy: challenging accepted management strategies. Aust N Z J Obstet Gynaecol.2009; 49: 346-51.
- Göktolga Ü. Ektopik Gebelik. Turkiye Klinikleri J Surg MedSci 2006; 2: 6
- Kirk E, Bourne T. The nonsurgical management of ectopic pregnancy. Curr Opin Obstet Gynecol 2006; 18: 587-93.
- Cagnacci A, Landi S, Volpe A. Rhythmic variation in the rate of ectopic pregnancy throughout the year. AmJ Obstet Gynecol 1999; 180: 1067-71.
- Buckley RG, King KJ, Disney JD, Gorman JD, Klausen JH. History and physical examination to estimate the risk of ectopic pregnancy: Validation of a clinical prediction model. Ann Emerg Med 1999; 34: 589-94.
- 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.
- Lundorff P, Hahlin M, Källfelt B, Thorburn J, Lindblom B. Adhesion formation after laparoscopic surgery in tubal pregnancy: A randomized trial versus laparotomy. Fertil Steril 1991; 55: 911-5.
- Lundorff P, Thorburn J, Hahlin M, Källfelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy. Acta Obstet Gynecol Scand 1991; 70: 343-8.
- Yao M, Tulandi T. Current status of surgical and nonsurgical management of ectopic pregnancy. Fertil Steril 1997; 67: 421-33.
- Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N. Risk factors for ectopic pregnancy: A comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol 2003; 157: 185-94.
- Storeide O, Veholmen M, Eide M, Bergsjİ P, Sandvei R. The incidence of ectopic pregnancy in Hordaland County, Norway 1976-1993. Acta Obstet Gynecol Scand 1997; 76: 345-9.
- Tancer ML, Delke I, Veridiano NP. A fifteen year experience with ectopic pregnancy. Surg Gynecol Obstet 1981; 152: 179-82.
- Job-Spira N, Coste J, Aublet-Cuvelier B, Germain E, Fernandez H, Bouyer J, Pouly JL. Incidence of extra-uterine pregnancy and characteristics of treated patients. First results of the auvergne registry. Presse Med 1995; 24: 351-5.
- Randic L, Haller H. Ectopic pregnancy among past IUD users. Int J Gynaecol Obstet 1992; 38: 299-304.
- Doyle MB, DeCherney AH, Diamond MP. Epidemiology and etiology of ectopic pregnancy. Obstet Gynecol Clin North Am 1991; 18: 1-17.
- Şahin HG, Zeteroğlu Ş. Sürücü R, Sucaklı MH, Kamacı M. Ektopik gebeliklerde risk faktörleri ve tanıyöntemlerinin değerlendirilmesi. Medical Network Klinik Bilimler ve Doktor. 2004; 10: 696-700.
- 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.
- Coste J, Job-Spira N, Fernandez H, Papiernik E, Spira A. Risk factors for ectopic pregnancy: A case-control study in France, with special focus on infectious factors. Am J Epidemiol 1991; 133: 839-49.
- Tharaux-Deneux C, Bouyer J, Job-Spira N, Coste J, Spira A. Risk of ectopic pregnancy and previous induced abortion. Am J Public Health 1998; 88: 401
- Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril 1996; 65: 1093-9.
- Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: A 10 year population-based study of 1800 cases. Hum Reprod 2002; 17: 3224-30.
- Alsuleiman SA, Grimes EM. Ectopic pregnancy: A review of 147 cases. J Reprod Med 1982; 27: 101-6.
- Turhan NÖ, İnegöl İ, Seçkin NC. A three-year audit of the management of ectopic pregnancy. J Turkish German Gynecol Assoc 2004; 5: 310-3.
- Agdi M, Tulandi T. Surgical treatment of ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 519-27.
- Strolego F, Rustico M, Pregazzi R. Seasonal incidence of extrauterine pregnancy. Minerva Ginecol 1995; 47: 499-502.
- Michelas S, Creatsas G, Fakas G, Kaskarelis D. Ectopic pregnancy: outcome of 152 cases. Int Surg 1980; 65: 355-8.
- 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 1994; 9: 742-5.
- Goldenberg M, Bider D, Seidman DS, Lipitz S, Mashiach S, Oelsner G. Seasonal patterns in tubal pregnancy. Gynecol Obstet Invest 1993; 35: 1495
- Römer T, Schmidt T, Negwer U, Rösel HD, Lober R. Is there a seasonal incidence of ectopic pregnancy?--A retrospective analysis. Zentralbl Gynakol 1994; 116: 628-30.
- Dubuisson JB, Morice P, Chapron C, De Gayffier A, Mouelhi T. Salpingectomy - the laparoscopic surgical choice for ectopic pregnancy. Hum Reprod 1996; 11: 1199-203.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 7 Mayıs 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 4 |