Kornual ektopik gebeliğin fetosit ve metotreksat ile tedavisi
Küçük Resim Yok
Tarih
2010
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kornual ektopik gebeliğin tanısı, yönetimi ve tedavisinin değerlendirilmesi Olgu: 28 yaşında primigravid olgunun takiplerinde sol kornual bölgede baş popo uzunluğuna (CRL) göre 11.5mm (7 hafta 2 gün) ile uyumlu, myometrial tabakayı oldukça incelten fetal kalp atımları (FHR ) pozitif embyo saptandı. Transabdominal ultrason eşliğinde gestasyonel sak içerisine 2cc potasyum klorur infuze edildi. 12 saat sonra gestasyonel sak kollabe ve FHR (-) saptandı. Rezidü trofoblastik aktivite için 75 mg intramuskuler metotreksat yapıldı. 19 gün boyunca yaptığımız seri ßhcg ve ultrason ölçümleri ile hasta takip edildi. Gebelik ürününün parsiyel rezolüsyonu ve ß hcg’ de düşüş izlendi. Transabdominal ultrason eşliğinde yapılan aspirasyon küretaj sonrasında fetoplasental bütünlük tamamen bozuldu. Sonuç: Kornual gebelik ender görülen bir ektopik gebeliktir. Maternal mortalitenin diğer tubal gebeliklere oranla yüksek olmasından dolayı son derece önemlidir. Sık nedenleri; geçirilmiş ektopik gebelik öyküsü, tubal hastalık, ipsilateral salpenjektomi, in vitro fertilizasyon ve pelvik adezyonlardır. Tedavi konservatif tıbbi tedavi veya cerrahi tedavi olabilir. Bizim kullandığımız yöntem fertilite korumaya yönelik olup histerektomiye kadar gidebilen tedavi seçenekleri mevcuttur. Bu yüzden tedavi kişiselleştirilmelidir.
Objective: The diagnosis, follow up and the treatment of a patient with cornual ectopic pregnancy Case: We present a case who has a pregnancy on the left cornual side of the uterus and seen corresponding with 7 weeks 2 days after ultrasound investigation with positive fetal heart rate (FHR +). Myometrial thickness was thinner than normally in this area. 2cc potassium chloride was injected into the gestationel sac under the guidance of transabdominal ultrasonography. Detection after 12 hours, we determined that gestationel sac had collapsed and FHR was negative. For residüel trophoblastic activity 75 mg intramusculer methotrexate was applied. The patient was followed up with the level of ß hCG and transvaginal ultrasonography for 19 days. Partial resolution of sac and deceleration at the level of ß hCG was determined. Uterin cavity was evacuated and gestationel sac was impaired totally under the guidance of transabdominal ultrasonography after these following processes. Result: Cornual ectopic pregnancy is rarely seen. It is so important that maternal mortality is higher than the other ectopic pregnancies. Ipsilateral salpengectomy, previous ectopic pregnancy, in vitro fertilization, pelvic adhesions are predisposing factors for interstisyel pregnancy. Treatment can be conservative or operative. Although preserving fertility is an advantage of our method, sometimes hysterectomy can be necessary. So the treatment shows difference patient to patient.
Objective: The diagnosis, follow up and the treatment of a patient with cornual ectopic pregnancy Case: We present a case who has a pregnancy on the left cornual side of the uterus and seen corresponding with 7 weeks 2 days after ultrasound investigation with positive fetal heart rate (FHR +). Myometrial thickness was thinner than normally in this area. 2cc potassium chloride was injected into the gestationel sac under the guidance of transabdominal ultrasonography. Detection after 12 hours, we determined that gestationel sac had collapsed and FHR was negative. For residüel trophoblastic activity 75 mg intramusculer methotrexate was applied. The patient was followed up with the level of ß hCG and transvaginal ultrasonography for 19 days. Partial resolution of sac and deceleration at the level of ß hCG was determined. Uterin cavity was evacuated and gestationel sac was impaired totally under the guidance of transabdominal ultrasonography after these following processes. Result: Cornual ectopic pregnancy is rarely seen. It is so important that maternal mortality is higher than the other ectopic pregnancies. Ipsilateral salpengectomy, previous ectopic pregnancy, in vitro fertilization, pelvic adhesions are predisposing factors for interstisyel pregnancy. Treatment can be conservative or operative. Although preserving fertility is an advantage of our method, sometimes hysterectomy can be necessary. So the treatment shows difference patient to patient.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Türk Jinekoloji ve Obstetrik Derneği Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
7
Sayı
1
