Obstetrics and Gynecology Department, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
Rev Bras Ginecol Obstet. 2020 Dec;42(12):800-804. doi: 10.1055/s-0040-1718444. Epub 2020 Dec 21.
In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy.
In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated.
Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed.
The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.
近年来，宫外孕的发病率有所上升；因此，三级中心报告其方法和结果对于扩大和改进治疗方法非常重要。本研究旨在评估诊断为宫外孕的病例的一般特征、治疗和结局。
回顾性分析 2016 年 2 月至 2019 年 6 月期间治疗的 432 例宫外孕患者。
共有 370 例患者为输卵管妊娠，32 例为剖宫产瘢痕妊娠，18 例为妊娠部位不明，6 例为宫颈妊娠，6 例为间质部妊娠。最重要的危险因素是年龄较大（>35 岁；患病率：31.2%）和吸烟（患病率：27.1%）。30 例无破裂症状且人绒毛膜促性腺激素（β-hCG）水平≤200mIU/ml 的患者进行期待治疗，316 例β-hCG 水平在 1500mIU/ml 至 5000mIU/ml 之间且经阴道或腹部超声未见宫内妊娠囊、无破裂表现的患者采用全身多剂量甲氨蝶呤治疗方案。共有 24 例对药物治疗无反应、20 例β-hCG水平>5000mIU/ml、16 例初诊时有破裂症状、6 例诊断为间质部妊娠的患者行手术治疗。宫颈和瘢痕妊娠患者行超声引导刮宫术，无需进一步治疗。
患者的生育状况、临床和实验室发现以及β-hCG 水平是制定适当治疗方案时必须考虑的因素。
