Senem Arda DUZ, Sevil ERASLAN, Ebru İnci COSKUN

Çok düşük B-hCG düzeylerinde rüptüre tubal gebelik: olgu sunumu

Ektopik gebelik uterin kavitenin dışında oluşan gebeliktir. Sıklıkla tubada olmak üzere abdominal kavite, over ve servikste görülebilir. Ruptüre ektopik gebeliklere bağlı anne ölümleri günümüzde transvajinal sonografi ve serum ?-hCG (beta human koryonik gonadotropin) ölçümleri ile oldukça azalmıştır. Ancak ektopik gebeliğin kliniği ile ?hCGdüzeyi arasında bir korelasyon yoktur. Çok düşük ?-hCG düzeylerinde ektopik gebelik ruptürü gelişen bir olguyu sunmaktayız. Adet rötarı ile başvuran 29 yaşındaki nullipar hastanın serum ?-hCG düzeyi 1051 mIU/ml olup ultrasonografide tubal gebelik düşünülmüş, akut batın bulguları olmaması ve 3. gün serum ?-hCG düzeyi 727 mIU/ml olması üzerine haftalık takibe alınmıştır. Son vizitinden 2 gün sonra şiddetli alt karın ağrısı ile başvurdu. ?-hCG düzeyi 39.8 mIU/ml idi. Ultrasonografide abdomende yaygın mai izlendi, acil laparotomi, sağ salpenjektomi yapıldı. ?-hCG düzeyleri düşük ve azalmakta olsa bile rüptür ihtimali her zaman akılda tutulmalı ve hastalar da bu konuda bilgilendirilerek takip edilmelidir.

Ruptured tubal pregnancy with very low BhCG levels: a case report

Ectopic pregnancy is a pregnancy that occurs outside the uterine cavity. Although tubal ectopic pregnancy is more common, it can be rarely seen in abdominal cavity, ovarium and cervix. Mortality caused by rupture of the ectopic pregnancy decreased dramatically with the introduction of sonography and measurement of serum ?-hCG (beta-human chorionic gonadotropin) levels. However there is no correlation between the clinical findings and ?-hCG levels. A 29-year-old nullipar woman with amenorrhea had a ?-hCG level of 1051 mUI/mL and ultrasonographic findings were pointing to tubal pregnancy. Because of the patient's stable clinical condition, it was decided to follow the patient with expectant management. When she was admitted with severe abdominal pain, the ?-hCG level was 39,8 mIU/ml and ultrasonography showed a large amount of fluid in the abdominal cavity. The patient underwent laparotomy (right) and salpengectomy. Even though ?-hCG levels are low and declining, the possibility of rupture should be kept in mind.

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