Department of Gynecology and Obstetrics, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Apr;27(8):3500-3507. doi: 10.26355/eurrev_202304_32122.
The goal of this study was to manage the treatment modalities of ectopic pregnancy.
This retrospective study included 1,103 women diagnosed and treated for ectopic pregnancy at Kanuni Sultan Suleyman Training and Research Hospital between January 1, 2017, and December 31, 2020. Serial beta-human chorionic gonadotropin (β-Hcg) measurements and transvaginal ultrasound (TV USG) findings were used to establish the diagnosis of an ectopic pregnancy. They were divided into four groups: expectant treatment, single-dose methotrexate, multidose methotrexate, and surgical treatment. All data analyses were performed using SPSS version 24.0. A receiver operating characteristic (ROC) analysis was used to determine the cut-off for change in beta-human chorionic gonadotropin (β-hCG) levels between the first and fourth day.
There were significant differences between groups in terms of gestational age and β-hCG changes (p < 0.001). In patients receiving expectant treatment, the decrease in β-hCG values on the fourth day was 35.19%, while patients receiving single-dose methotrexate treatment showed a decrease of 24%. The most common risk factor for ectopic pregnancy was the absence of risk factors. Comparison of the surgical treatment group with the other groups revealed significant differences in terms of the presence of free fluid in the abdomen, the average diameter of the ectopic pregnancy mass, and the presence of fetal cardiac activity. A single dose of methotrexate was effective in patients with β-hCG levels lower than 1,227.5 mIU/ml, with a 68.5% sensitivity and 69.1% specificity.
An increase in gestational age also leads to an increase in β-hCG values and the diameter of the ectopic focus. As the diagnosis period progresses, the need for surgical intervention increases.
本研究旨在管理异位妊娠的治疗方式。
本回顾性研究纳入了 2017 年 1 月 1 日至 2020 年 12 月 31 日期间在 Kanuni Sultan Suleyman 培训和研究医院诊断和治疗异位妊娠的 1103 名女性。连续的β-人绒毛膜促性腺激素（β-HCG）测量和经阴道超声（TV USG）检查结果用于确定异位妊娠的诊断。将她们分为四组：期待治疗、单次甲氨蝶呤、多次甲氨蝶呤和手术治疗。所有数据分析均使用 SPSS 版本 24.0 进行。使用接收者操作特征（ROC）分析确定β-人绒毛膜促性腺激素（β-hCG）水平在第 1 天和第 4 天之间变化的截断值。
在妊娠年龄和β-hCG 变化方面，各组之间存在显著差异（p < 0.001）。在接受期待治疗的患者中，第 4 天β-hCG 值下降了 35.19%，而接受单次甲氨蝶呤治疗的患者下降了 24%。异位妊娠最常见的危险因素是无危险因素。与其他组相比，手术治疗组在腹部游离液、异位妊娠肿块的平均直径和胎儿心脏活动方面存在显著差异。对于β-hCG 水平低于 1227.5 mIU/ml 的患者，单次甲氨蝶呤治疗有效，其敏感性为 68.5%，特异性为 69.1%。
妊娠年龄的增加也会导致β-hCG 值和异位病灶直径的增加。随着诊断期的进展，手术干预的需求增加。
