Düşük BHCG Değerli Bir Ektopik Gebelik Olgu Sunumu

Ektopik gebelik, fertilize olmuş ovumun uterus dışında, sıklıkla fallop tüplerinde implante olması olarak tanımlanmaktadır. Ektopik gebeliğin tanısında; anamnez, fizik ve jinekolojik muayene, ultrasonografi, serum β-hCG değerleri, culdosynthesis, D&C ve laparoskopi kullanılmaktadır. Ektopik gebelik, medikal veya cerrahi olarak tedavi edilebilir ya da yalnızca izlenebilir. Her iki yöntemde etkilidir. Tercih; klinik duruma, ektopik gebelik lokalizasyonuna ve mevcut olanaklara bağlıdır. Bu olgu sunumunda kasık ağrısı ile polikliniğe başvuran, β-hCG değeri düşük olan intraoperatif ektopik gebelik düşünülen ve patoloji sonucu da ektopik gebelik ile uyumlu gelen bir olgu sunulacaktır.

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