İki Servikal Gebelik Olgusunda İki Tedavi Yönteminin Farklı Sıralarla Uygulanması

Servikal gebelik, gebeliğin endoservikal kanalda yerleştiği nadir görülen bir ektopik gebelik türüdür. Günümüzde erken tanı ile hayatı tehdit edebilen vajinal kanama başlamadan önce gebeliğin sonlandırılması sağlanarak reprodüktif dönemdeki bu hastalarda histerektomi ihtiyacı azaltılmıştır. Bu amaçla, sistemik metotreksat uygulaması ve ultrason eşliğinde iğne yardımı ile gebeliğin sonlandırılması kolay uygulabilir iki tedavi seçeneğidir. Kliniğimize başvuran iki servikal gebelik olgusuna farklı sıralarla ardışık olarak 50 mg/m2 dozunda sistemik tek doz intravenöz metotreksat ve ultrasonografi eşliğinde gebelik kesesi aspirasyonunu takiben 50 mg metotreksat uygulandı. İkinci olguda tedavi öncesi β-hCG düzeyi ilk olguya oranla yüksek olup (23898 mIU/ml, 1881 mIU/ml), 1 hafta sonra başlayan vajinal kanama nedeniyle servikal kanalın vakum aspirasyonu gerekti. İlk olguda 8 haftanın sonunda negatifleşen β-hCG değeri, ikinci olguda vakum aspirasyonunu takiben 1. haftada sıfırlandı. Servikal gebeliğin sonlandırılmasında bu iki yöntemin farklı sıralarla ardışık kullanımı ve etkinliği literatür eşliğinde tartışılmıştır.

The alternating successive use of two treatment modalities in two cervical pregnancy cases

Cervical pregnancy is a rare form of ectopic pregnancy which implants in the endocervical canal. Nowadays with early diagnosis it is possible to terminate cervical pregnancies before life threatening vaginal bleeding starts and hence the need for hysterectomy is reduced in these women of reproductive age. For this purpose, systemic methotrexate and ultrasound guided needle aspiration of gestational sac are two easy-to-implement treatment modalities. Two cervical pregnancy cases were treated consecutively in alternative orders with systemic single dose intravenous methotrexate at 50 mg/m2 dose and 50 mg local methotrexate administered after transvaginal ultrasound assisted needle aspiration of the gestational sac. In the second case, a vacuum aspiration of the cervical canal was necessary due to the higher β-hCG levels (23898 mIU/ml versus1881 mIU/ml) at the beginning of the treatment. While it took 8 weeks for β-hCG level to reach undetectable levels in the first case, it took merely 1 week after vacuum aspiration of the cervical canal in the second case. In this case report, we discuss the successive use and the efficacy of two methods in termination of cervical pregnancies with review of the literature.

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