Objective: Ectopic pregnancy is the implantation of the pregnancy product anywhere other than the endometrium. The increasing frequency and earlier diagnosis have brought conservative methods to the fore in treatment. Conservative methods include monitoring, medical treatment and surgical treatment methods. The patient's presenting clinic and symptoms determine the treatment approach. In our article, we aimed to present our 26-year-old case who applied to us with complaints of vaginal bleeding and groin pain and was diagnosed with ectopic pregnancy.
Results: Pelvic ultrasonography revealed an approximately 25 mm gestational sac compatible with the tubal ring in the right adnexal region. A fetus with a yolk sac and a positive fetal heartbeat was observed within the gestational sac. A hematoma area of 55x75 mm in size was observed adjacent to the gestational sac and free fluid of approximately 4 cm in its widest diameter was observed in the douglas. In the transvaginal ultrasonography, shifted IUD echogenicity was observed in the uterine cavity. Laboratory tests revealed ß-hCG: 12560 IU/mL, Hb: 10.4 g/dL. Since the patient's vital signs were diagnosed as ruptured ectopic pregnancy and there was no evidence of active bleeding in serial hemoglobin follow-ups, a single dose of methotrexate at 50 mg/m2 was administered intramuscularly. In the patient's 4th day control ultrasonography, the fetal heartbeat in the right adnexal area was observed to be negative. No increase in free fluid was detected in the hematoma area or douglas. On the 4th day, ß-hCG: 15540 IU/mL, Hb: 10.2 g/dL were detected. In the patient's 7th day follow-up ultrasonography, a 35x52 mm sized hematoma area in the right adnexal area and approximately 2.5 cm of free fluid in the widest diameter in the douglas were observed. Upon detection of ß-hCG: 14680 IU/mL, Hb: 10.1 g/dL on the 7th day, the patient was administered a second dose of methotrexate. The patient was followed up after ß-hCG: 10280 IU/mL, Hb: 10.2 g/dL was detected on the 11th day. ß-hCG was found to be negative in the blood test performed 28 days after the application. No pathology was observed in simultaneous ultrasonography.
Conclusion: Ectopic pregnancies constitute approximately 1.5-2% of pregnancies. Surgical and medical methods can be used in the treatment of ectopic pregnancy. Especially in cases of fetal cardiac activity, ectopic gestational sac width >3.5cm, high ß-hCG (ß-hCG>15000) and rupture, surgery is the primary treatment method. Although our patient's ß-hCG level was high and signs of rupture were detected, he responded to medical treatment and the patient was protected from invasive interventions. ORCID NO: 0000-0002-2109-1373
Anahtar Kelimeler: Ectopic Pregnancy, Methotrexate, Rupture