Ektopik Gebeliklerde Tek Doz Metotreksat Tedavisinin Etkinliğinin Değerlendirilmesi: 5 Yıllık Deneyim

Amaç: Bu çalışmada ektopik gebeliklerde tek doz metotreksat tedavisinin başarı ve başarısızlık oranlarını değerlendirmesi amaçlandı. Materyal ve Metot: Çalışmada ektopik gebelik tanısı konulup tek doz metotreksat uygulanan 351 hastanın tıbbi kayıtlarının retrospektif olarak incelenmiştir. Hastalar tek doz metotreksat ile başarılı olarak tedavi edilen ve edilemeyen olmak üzere 2 gruba ayrılarak değerlendirilmiştir.Bulgular: 351 hastanın 240 (%68,3) tek doz MTX ile başarılı olarak tedavi edilmiştir. 111 (%31,7) hasta ikinci bir MTX dozuna ya dacerrahi tedaviye ihtiyaç duymuştur. Ortalama BHCG seviyeleri tek doz MTX tedavisine başarılı olarak yanıt veren grupta, başarısız olunan gruba göre belirgin olarak düşük saptandı. (1265 mIU/ml-5751 mIU/ml, p<0,001). Tedaviye başarılı olarak yanıt veren grupla başarısız olunan grup arasında 4. gün BHCG seviyelerindeki düşüş oranı arasında istatistiksel olarak anlamlı fark saptandı. (%62,5 ve %36,9 istatiksel anlamlı, p<0,0001). Tek doz MTX tedavisine başarılı yanıt BHCG seviyeleri <1000 olduğunda %95, 1000–1999 arasında %87,5, >5000 olduğunda %35,5 olarak saptandı.Sonuç: Tek doz MTX uygulamaları ektopik gebeliklerin medikal tedavisinde kabul edilebilir, güvenli ve efektif bir yöntemdir, özellikle BHCG seviyeleri 3000 altında olan hastalarda ilk seçenek olarak düşünülmelidir.

Anahtar Kelimeler:

ektopik gebelik, metotreksat, medikal tedavi

Evaluation of Medical Treatment Success in Ectopic Pregnancy with Single Dose Methotrexate: 5 Year Experience

Aim: The aim of this study was to evaluate the predictive factors of success or failure of treatment of Ectopic Pregnancy with singledose Methotrexate (MTX).Material and Method: In this retrospective study, records of 351 patients who were treated for ectopic pregnancy with single doseof MTX were reviewed during five years. Patients were divided into two groups; the first group or “success group” are the patientswho were successfully treated with MTX. The second group or “failure group” consist the patients who did not respond to the MTX therapy.Results: Of 351 patients, 240 (68.3%) were successfully treated with single dose MTX. 111 patients (31.7%) required second doseMTX or a surgery. The mean initial BHCG level was significantly lower in the treatment success group than in the treatment failuregroup (1265 mIU/ml versus 5751 mIU/ml, p<0.001). The number of cases with decreasing BHCG level on day 4 was significantlymore in the success group compared to failure group (62.5% and 36.9% respectively, p<0.0001). The success rate was 95% whenthe levels were <1000 mIU/ml, 87.5% when the levels were between 1000–1999 mIU/ml and 35.5% when the levels were >5000mIU/ml.Conclusion: Medical treatment with single dose systemic MTX may be an acceptable therapeutic option for ectopic pregnancyand MTX therapy is a safe and effective treatment modality for ectopic pregnancies with a serum BHCG levels below 3000 mIU/ml.

Keywords:

Ectopic pregnancy, methotrexate, medical treatment,

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