Abdülkadir TURGUT, Meryem HOCAOĞLU, Oğuz Devrim YARDIMCI, Taner GÜNAY, Ergül DEMİRÇİVİ BOR, Ateş KARATEKE

Ektopik Gebelikte Kullanılan Tek Doz Metotreksat Tedavisinin Başarısını Etkileyen Faktörler

GİRİŞ ve AMAÇ: Bu çalışmamızın amacı ektopik gebelik tedavisinde uyguladığımız tek doz metotreksat tedavisinin başarı oranını değerlendirmek ve bu başarı oranını etkileyen klinik ve laboratuar faktörlerini araştırmaktır. YÖNTEM ve GEREÇLER: Hastanemize 2013 Nisan ile 2018 Nisan arasında ektopik gebelik tanısıyla tek doz metotreksat tedavisi alan hastalar retrospektif olarak değerlendirildi. Hastaların demografik özelliklerinin yanı sıra tanı anındaki serum β-hCG değeri, ektopik odak boyutu ile ektopik odaktaki fetal kardiyak aktivite pozitifliği gibi klinik, laboratuar ve ultrasonografik bulgular ile metotreksat tedavisi arasındaki ilişki değerlendirildi. BULGULAR: Ektopik gebelik tanısı ile tek doz metotreksat tedavisi yapılan toplam 123 hasta çalışmaya dahil edildi ve hastalar 2 gruba ayrıldı. Grup 1(n=97): Tek doz metotreksat ile başarılı tedavi edilen hastalar. Grup 2(n=26): Tek doz metotreksat ile başarı sağlanamayan ve cerrahi müdahale gereken hastalar. Grup 1’deki hastaların MTX tedavisi öncesi ortalama serum β-hCG değeri 3128 ± 2085 mIU/ml iken Grup 2’deki hastaların ortalama değeri 5813 ± 3858 mIU/ml olarak bulundu ve her iki grup arasında istatistiksel olarak anlamlı fark bulundu (p=0.0001). Ektopik odaktaki fetal kardiyak aktivite Grup 1’de 10 (%10.3) hastada, Grup 2’de ise 7 (%26.9) hastada pozitif bulundu. Toplam 123 hastaya MTX tedavisi uygulandı ve genel başarı oranı 97/123 (%78.8) olarak bulundu. TARTIŞMA ve SONUÇ: Tek doz metotreksat tedavisi ektopik gebeliğin tedavisi için kullanılan etkin ve güvenli bir tedavi seçeneğidir. Metotreksat tedavisinin başarısını öngören en önemli parametre serum β-hCG düzeyi olup tanı anındaki β-hCG değeri ile medikal tedavinin başarı oranı arasında ters orantı söz konusudur. Ektopik odakta kardiyak aktivitenin gözlenmesi de metotreksat tedavisi için kesin bir kontrendikasyon olmasa da tedavi başarısını azaltan önemli bir parametre olarak bulunmuştur.

Factors Affecting Success of Single-Dose Methotreaxhate Treatment in Ectopic Pregnancy

INTRODUCTION: We aimed to evalute the affectiveness of the single-dose methotreaxhate used in the treatment of ectopic pregnancy and and to identify the clinical and laboratory findigns affecting its success.METHODS: We retrospectively reviewed the patients diagnosed with ectopic pregnancy who received single-dose methotraxhate treatment in between April 2013 and April 2018. The associations of the methotreaxhate treatment with patients’ s demographic characteristics, clinical and laboratory finding like serum β-Hcg levels, size of ectopicmass, fetal cardiac positivity were evaluated.RESULTS: Mean serum β-hCG levels of Group 1 (included patients succesfully treated with single-dose methotreaxhate,n=97) and Group 2 (included patients could not treated with single-dose methotreaxhate, n=26) prior to methotreaxhate treatment were 3128 ± 2085 mIU/ml and 5813 ± 3858 mIU/ml recpectively. In Group 1, fetal cardiac activitywas positive in 10 patients (10,3%) and in Group 2. The cardiac fetal activity was positive in 10 patients (10.3%) in Group 1 and 7 patients (26.9%) in Group 2. In total 123 patients who underwent methotreaxhate treatment the overall success rate of single-dose methotreathate treatment was found as 78.8% (97/123).DISCUSSION and CONCLUSION: Single-dose methotreaxhate treatment is a safe and effective option in ectopic pregnancy therapy. The most significant parameter affecting the success of this treatment is the serum β-Hcg levels having an inverse relation with success rate. The observation of cardiac activity in the ectopic focus has been found to be an important parameter that reduces the success of treatment,although not being a definite contraindication to methotrexate therapy.

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