ABSTRACT

Objective:

The aim of our study was to evaluate demographic characteristics, risk factors, clinical and labarotory findings of cases with ectopic pregnancy at a tertiary health care center in a five-year period.

Material and Methods:

Clinical data of 121 ectopic pregnancy cases treated between 2006-2011 had been evaluated, retrospectively. The age of cases, obstetric histories, causes of application, examination findings, risk factors, β-hCG levels, transvaginal ultrasound findings and trearment methods had been reviewed. Statistical analyses has been carried out by Independent Samples T Test, Fischer’s Exact Test and Mann Whitney U Test; p<0.05 has been accepted as statistically significant.

Results:

Mean age was 31.1±5.3 years; mean gestational age–as to the first day of last period-was 6.3±1.6 weeks at the time of diagnosis. Of the patients, 20.7% were primigravid and 31.4% were nulliparous. As 5.7% of all cases had applied only delayed menstruation, two cases had no symptoms. The most frequent symptom was inguinal and abdominal pain (38%). There was a history of previos ectopic pregnancy in 5.8% cases and pelvic surgery in 32.4%; 13.2% cases had intrauterine device, 4.1% had ectopic pregnancy following an assisted reproductive technique. Acute abdominal pain was found in 55.4%. In transvaginal ultrasound imaging, gestational sac was detected in 82 cases; of these 13 had fetal heart beat. There was no pathological ultrasound findings in 9.9% patients. Mean β-hCG level at the time of diagnosis was 3272±3918 IU/ml. In 67 cases, it was thought that ectopic pregnancy was complicated. Of these, 24 had been accepted as hemodynamically stable. It was seen that β-hCG levels of complicated group (n=67) and non-complicated group (n=54) was similar (3320 ±2310 vs 3633±4475 IU/ml, p=0.754).

Surgical treatment models have been used in 43 complicated patients with unstable hemodynamic parameters. Methotrexate has been applied to 45 of 121 cases as the first treatment choice and achievement drive was calculated as 80%. Wait-and-see method was used in 7 cases and it was succeeded in 5 cases. β-hCG levels were significantly higher in cases that systemic methotrexate application failed (p=0.002). Laparoscopic methods was used in 53.1% and laparotomy was used in the rest (46.9%) of 64 patients who underwent surgery. Salpingostomy was performed in 25% cases and salpingectomy in 75%. Of the patients who were hemodynamically unstable, laparotomy was carried out in 65% (28/43) and salphingectomy was performed on all of these cases.

Conclusion:

In ectopic pregnancy, treatment options should be personalized as to the condition of each patient and fertility protective conservative methods must be considered. Medical treatment options should be presented prior to surgery in complicated ectopic pregnancy cases as long as they are hemodynamically stable.