Research Article
Year 2018,
Volume: 3 Issue: 2, 41 - 44, 24.04.2018
Abstract
Amaç: Rüptüre olmamış ektopik gebeliğin ayaktan tedavisi için
seçim kriterlerini değerlendirmek.
Yöntemler: Düzce
Üniversitesi Tıp Fakültesi, Eğitim ve Araştırma Hastanesi'nde 2012-2017 yılları
arasında tek doz intramusküler metotreksat enjeksiyonları ile tedavi edilen
toplam 124 rüptüre olmamış ektopik gebelik retrospektif olarak
değerlendirildi.
Bulgular: Tek
doz metotreksat ile medikal tedavi 124 hastanın % 76,61'inde (n = 95)
başarılı bulundu. Başarılı olarak tedavi edilen grupta ortalama hastanede kalış
süreleri daha kısa idi (p=0,030). Metotreksat enjeksiyonunun 1.günü β-hCG
düzeyinin ektopik odak büyüklüğü ve / veya batın içinde sıvı varlığı ile
birleşmesi metotreksat ile başarılı bir şekilde tedavi edilmek üzere duyarlılık,
özgüllük ve pozitif öngörüyü anlamlı olarak arttırmıştır (duyarlılık= %70,3,
özgüllük= %86,3, pozitif kestirim değeri= %80).
Sonuç: Başlangıç serum β-hCG seviyeleri,
ektopik odak büyüklüğü ve batında sıvı varlığı ile metotreksat tedavisine iyi
yanıt verecek hastaları, hastane yatışı gerektirmeden seçebiliriz.
Keywords
References
- 1. Yıldız A, Doğan O. Ektopik Gebelik Olgularının Yönetimi ve FertiliteDurumları: BeşYıllık Tek Merkezli Çalışma. Turkiye Klinikleri J Gynecol Obst. 2016;26:93-7.
- 2. Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991–1997. Obstet Gynecol. 2003;101: 289-96.
- 3. Pulatoglu Ç, Doğan O, Basbug A, Ellibes Kaya A, Yildiz A, Temizkan O. Predictive Factors of Methotrexate Treatment Success in Ectopic Pregnancy: A Single Tertiary Center Study. North Clin Istanb. 2017. DOI:10.14744/nci.2017.04900.
- 4. Yıldız A, Doğan O. Evaluation of Medical Treatment Success in Ectopic Pregnancy with Single Dose Methotrexate: 5 years Single Center Experience. Kafkas J Med Sci. 2017; 7:188-92.
- 5. Rodi IA, Sauer MV, Gorrill MJ. The medical treatment of unruptured ectopic pregnancy with methotrexate and citrovorum rescue: preliminary experience. Fertil Steril. 1986;46:811-3.
- 6. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115:495-502.
- 7. Capmas P, Bouyer J, Fernandez H. Treatment of ectopic pregnancies in 2014: new answers to some old questions. Fertil Steril. 2014;101:615- 20.
- 8. Jurkovic D, Wilkinson H. Diagnosis and management of ectopic pregnancy. BMJ. 2011; 342: d3397.
- 9. Seror V, Gelfucci F, Gerbaud L, Pouly JL, Fernandez H, Job-Spira N, et al. Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis. Fertil Steril. 2007;87:737- 48.
- 10. Mol F, Mol BW, Ankum WM, van der Veen F, Hajenius PJ. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and metaanalysis. Hum Reprod Update. 2008; 14:309-19.
- 11. Lecuru F, Camatte S, Viens-Bitker C, Chasset S, Leonard F, Taurelle R. Hospital Resources Used for Ectopic Pregnancy Treatment by Laparoscopy and Methotrexate. JSLS. 2001;5:117-22.
- 12. Uğurlucan FG, İyibozkurt AC, Çetin C, Nehir A, Akhan S. Methotrexate treatment for ectopic pregnancy: Factors affecting treatment outcome. Ege J Med. 2013;52:199-204.
- 13. Yenicesu C, İmir G, Çetin M, Küçüközkan T. Evaluation Of The Treatment Modalities And Hospitalization Period In Patients With Acute Pelvic Pain Related To Adnexal Pathologies. C.Ü. Tıp Fakültesi Dergisi. 2008;30:1-7.
- 14. Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361:379-87.
- 15. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol. 2008;111:1479-85.
- 16. Ory SJ, Villanueva AL, Sand PK, Tamura RK. Conservative treatment of ectopic pregnancy with methotrexate. Am J Obstet Gynecol. 1986;154:1299-306.
- 17. Corsan GH, Karacan M, Qasim S, Bohrer MK, Ransom MX, Kemmann E. Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy, Hum Reprod. 1995;10:2719-22.
- 18. Nazac A, Gervaise A, Bouyer J, de Tayrac R, Capella-Allouc S, Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies, Ultrasound Obstet Gynecol. 2003;21:181-5.
- 19. Cohen A, Zakar L, Gil Y, Amer-Alshiek J, Bibi G, Almog B, et al. Methotrexate success rates in progressing ectopic pregnancies: a reappraisal. Am J Obstet Gynecol. 2014;211:128.e1-5.
- 20. Sagiv R, Debby A, Feit H, Cohen-Sacher B, Keidar R, Golan A. The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy. Int J Gynaecol Obstet. 2012;116:101-4.
- 21. Nazac A, Gervaise A, Bouyer J, de Tayrac R, Capella-Allouc S, Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound Obstet Gynecol. 2003;21:181-5.
- 22. Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG. 2001;108:192-203.
- 23. Var A, Özyurt R, Şık BA, Kumbasar S, Sever E, Deveci M, et al. Retrospective analysis of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy. Turk J Obstet Gynecol. 2015;12:215-9.
- 24. Westaby DT, Wu O, Duncan WC, Critchley HO, Tong S, Horne AW. Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery? BMC Pregnancy Childbirth. 2012;12:98.
- 25. Bachman EA, Barnhart K. Medical Management of Ectopic Pregnancy: A Comparison of Regimens. Clin Obstet Gynecol. 2012;55:440-7.
Year 2018,
Volume: 3 Issue: 2, 41 - 44, 24.04.2018
Abstract
Aim: To evaluate the selection
criteria for outpatient treatment of unruptured ectopic pregnancy.
Methods: A total of 124
unruptured ectopic pregnancies that had been treated with single-dose
intramuscular methotrexate injections during the period from 2012 to 2017 at Duzce
UniversityFaculty of Medicine, Training and Research Hospital were evaluated.
Results: Success rate of the
medical treatment with single dose methotraxate was 76.61% (n = 95) of 124
patient. The mean duration of hospital stay was shorter in successful medical
treatment group (p=0.030). Combining β-hCG level at the first day of methotrexate
treatment with size of ectopic focus and/or the presence of fluid in the
abdomen significantly increased the sensitivity, specificity and positive predictivity
for successfully treated with methotrexate (sensitivity = 70.3%, specificity
=86.3%, positive predictive value =80%).
Conclusions: We can choose
patients that will be good responder to methotrexate treatment of ectopic
pregnancy without hospitalization by initial serum β-hCG values, size of
ectopic focus and the presence of fluid in the abdomen.
References
- 1. Yıldız A, Doğan O. Ektopik Gebelik Olgularının Yönetimi ve FertiliteDurumları: BeşYıllık Tek Merkezli Çalışma. Turkiye Klinikleri J Gynecol Obst. 2016;26:93-7.
- 2. Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991–1997. Obstet Gynecol. 2003;101: 289-96.
- 3. Pulatoglu Ç, Doğan O, Basbug A, Ellibes Kaya A, Yildiz A, Temizkan O. Predictive Factors of Methotrexate Treatment Success in Ectopic Pregnancy: A Single Tertiary Center Study. North Clin Istanb. 2017. DOI:10.14744/nci.2017.04900.
- 4. Yıldız A, Doğan O. Evaluation of Medical Treatment Success in Ectopic Pregnancy with Single Dose Methotrexate: 5 years Single Center Experience. Kafkas J Med Sci. 2017; 7:188-92.
- 5. Rodi IA, Sauer MV, Gorrill MJ. The medical treatment of unruptured ectopic pregnancy with methotrexate and citrovorum rescue: preliminary experience. Fertil Steril. 1986;46:811-3.
- 6. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115:495-502.
- 7. Capmas P, Bouyer J, Fernandez H. Treatment of ectopic pregnancies in 2014: new answers to some old questions. Fertil Steril. 2014;101:615- 20.
- 8. Jurkovic D, Wilkinson H. Diagnosis and management of ectopic pregnancy. BMJ. 2011; 342: d3397.
- 9. Seror V, Gelfucci F, Gerbaud L, Pouly JL, Fernandez H, Job-Spira N, et al. Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis. Fertil Steril. 2007;87:737- 48.
- 10. Mol F, Mol BW, Ankum WM, van der Veen F, Hajenius PJ. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and metaanalysis. Hum Reprod Update. 2008; 14:309-19.
- 11. Lecuru F, Camatte S, Viens-Bitker C, Chasset S, Leonard F, Taurelle R. Hospital Resources Used for Ectopic Pregnancy Treatment by Laparoscopy and Methotrexate. JSLS. 2001;5:117-22.
- 12. Uğurlucan FG, İyibozkurt AC, Çetin C, Nehir A, Akhan S. Methotrexate treatment for ectopic pregnancy: Factors affecting treatment outcome. Ege J Med. 2013;52:199-204.
- 13. Yenicesu C, İmir G, Çetin M, Küçüközkan T. Evaluation Of The Treatment Modalities And Hospitalization Period In Patients With Acute Pelvic Pain Related To Adnexal Pathologies. C.Ü. Tıp Fakültesi Dergisi. 2008;30:1-7.
- 14. Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361:379-87.
- 15. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol. 2008;111:1479-85.
- 16. Ory SJ, Villanueva AL, Sand PK, Tamura RK. Conservative treatment of ectopic pregnancy with methotrexate. Am J Obstet Gynecol. 1986;154:1299-306.
- 17. Corsan GH, Karacan M, Qasim S, Bohrer MK, Ransom MX, Kemmann E. Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy, Hum Reprod. 1995;10:2719-22.
- 18. Nazac A, Gervaise A, Bouyer J, de Tayrac R, Capella-Allouc S, Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies, Ultrasound Obstet Gynecol. 2003;21:181-5.
- 19. Cohen A, Zakar L, Gil Y, Amer-Alshiek J, Bibi G, Almog B, et al. Methotrexate success rates in progressing ectopic pregnancies: a reappraisal. Am J Obstet Gynecol. 2014;211:128.e1-5.
- 20. Sagiv R, Debby A, Feit H, Cohen-Sacher B, Keidar R, Golan A. The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy. Int J Gynaecol Obstet. 2012;116:101-4.
- 21. Nazac A, Gervaise A, Bouyer J, de Tayrac R, Capella-Allouc S, Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound Obstet Gynecol. 2003;21:181-5.
- 22. Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG. 2001;108:192-203.
- 23. Var A, Özyurt R, Şık BA, Kumbasar S, Sever E, Deveci M, et al. Retrospective analysis of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy. Turk J Obstet Gynecol. 2015;12:215-9.
- 24. Westaby DT, Wu O, Duncan WC, Critchley HO, Tong S, Horne AW. Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery? BMC Pregnancy Childbirth. 2012;12:98.
- 25. Bachman EA, Barnhart K. Medical Management of Ectopic Pregnancy: A Comparison of Regimens. Clin Obstet Gynecol. 2012;55:440-7.
There are 25 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Original Research |
| Authors | |
| Publication Date | April 24, 2018 |
| Published in Issue | Year 2018 Volume: 3 Issue: 2 |
