ALPER BAŞBUĞ, Aşkı ELLİBEŞ KAYA, Mete ÇAĞLAR, ALİ YAVUZCAN

Anrüptüre tubal ektopik gebeliklerde ayaktan metotreksat tedavi stratejileri

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.

Anahtar Kelimeler:

ektopik gebelik, metotreksat, ayaktan tedavi

Outpatient methotrexate treatment strategies for unruptured tubal ectopic pregnancy

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.

Keywords:

outpatient treatment, ectopic pregnancy, methotrexate,

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