Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği'nde Ocak 2004 ile Ocak 2009 yılları arasında tedavi gören ektopik gebelik vakalarının retrospektif değerlendirilmesi

Amaç: Ektopik gebelik tanısı koyulan hastaların risk faktörleri, tanı yöntemleri, tedavi seçenekleri ve sonuçları açısından retrospektif analizlerini yapmak. Yöntem ve Gereç: Ocak 2004-ocak 2009 yılları arasında kliniğimizde ektopik gebelik tanısı konulan ve tedavisi yapılan 128 olgu retrospektif olarak analiz edildi. Tüm olgular risk faktörleri, tanısal yöntemler ve tedavi seçeneklerine göre değerlendirildi. Bulgular: Tüm olgular anamnezlerine göre değerlendirildiğinde amenore ve vajinal kanama oranları sırası ile %90,6 ve %60,9 idi. Başvuru esnasında olguların %47,7'sinde β-HCG(insan koryonik gonadotropin) 5-1500IU/L arasında bulundu. Transvajinal ultrasonografide (TV-USG) olguların %89,8'de ektopik gebelikle ilişkili bulgular izlendi. Ektopik gebelik için risk faktörleri azalan sıklık oranlarına göre geçirilmiş batın cerrahisi (%33,6), infertilite (%14,8), geçirilmiş ektopik gebelik (%8,6), ovulasyon indüksyonu (%1,6) ve endometriyozis (%0,8) idi. En sık kullanılan korunma yöntemi kondom (%21,9) ve ikinci sıklıkta kullanılanı ise rahim içi araçtı (%10,9). Başvuru esnasında olguların %6,3'ü şokta idi ve %18,8'inde kan ürünleri transfüzyonu ihtiyacı mevcuttu. Tedavi seçenekleri ve oranları salpinjektomi (%56,3), salpingostomi (%16,4), tek taraflı salpingo-ooferektomi (%1,6) ve tubal sağma (%1,6) idi. Ultrasonografik bulgular ve medikal tedavi arasında negatif korelasyon (p=0,001) varken douglastaki kan ile hem salpinjektomi (p=0,0001) hem de kan transfüzyonu (p=0,001) arasında pozitif korelasyon mevcut idi. Ayrıca benzer pozitif korelasyon salpinjektomi ve kan transfüzyonu (p=0,04) arasında da izlendi. Sonuç: Sunulan çalışmada ektopik gebelik için risk faktörü olarak en sık geçirilmiş cerrahi operasyonlar; kontrasepsiyon yöntemleri arasında en sık kondom kullanımı; tanıda anamnez, β-HCG ve TV-USG'nin etkinliği, tedavide özellikle batın içi kanaması bulunan ve kan transfüzyonu uygulanmış olgularda salpinjektominin en sık kullanılan yöntem olarak öne çıkmaktadır.

Retrospective analyses of the ectopic pregnancy cases treated between January 2004 - January 2009 in the Obstetrics and Gynecology Clinic at Ege University

Aim: Retrospective analysis of risk factors, diagnostic procedures, treatment choices and results in cases of ectopic pregnancy. Material and Methods: Between the years of January 2004-January 2009, 128 cases who were diagnosed and treated as ectopic pregnancy in our clinic. All were analysed retrospectively. All cases were evaluated according to their risk factors, diagnostic procedures and treatment choices. Results: When all cases were evaluated by history, amenore and vaginal bleeding were %90,6 and %60,9. β-HCG was analysed between 5-1500IU/L at admission in %47,7 of the cases. TV-USG revealed ectopic pregnancy related signs in %89,8 of the cases. Risk factors for ectopic pregnancy were recent abdominal surgery (%33,6), infertility (%14,8), recent ectopic pregnancy (%8,6), ovulation induction (%1,6), endometriosis (%0,8), and pelvic inflammatory diseases (%0) in descending ratio. Most common types of contraception were condoms (%21,9) with the second being an intrauterine device (%10,9). At admission %6,3 of the patients were in shock and %18,8 of the cases were transfused blood components. Treatment choices were salpingectomy (%56,3), salpingostomy (%16,4), unilateral salpingo-oophorectomy (%1,6) and tubal milking (%1,6) There was a negative correlation between medical treament and ultrasonographic findings, whereas there was a positive correlation between blood in douglas and salpingectomy ,blood in douglas and blood transfusion, as well as in salpingectomy and blood transfusion (p=0,000, p=0,001,p=0,04). Conclusion: In this retrospective study we observed that recent abdominal surgery is the most important risk factor for ectopic pregnancy, and the most common contraception method is a condom. Anamnesis, β-HCG and TV-USG is effective for diagnosis and salpingectomy is the most common treatment method for cases where there is a need for transfusion and where intra-abdominal bleeding is present.

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