EKTOPİK GEBELERİN RETROSPEKTİF ANALİZİ VE MEVSİMLERE GÖRE DAĞILIMININ DEĞERLENDİRİLMESİ Retrospective Analysis of Ectopic Pregnancies and Evaluation of Seasonal Variation

OZET Amac: Bu calismanin amaci klinigimizde ektopik gebelik tanisi konulan hastalarin demografik ozelliklerini incelemek, medikal ve cerrahi tedavi basari oranlarini degerlendirmek ve ektopik gebeliklerin gorulme sikliginin mevsimlere gore dagilimini analiz etmektir. Gerec ve Yontemler: Ocak 2015-Ocak 2018 tarihleri arasinda, Trabzon Medikal Park Hastanesi Kadin Hastaliklari ve Dogum Klinigine basvuran ve ektopik gebelik tanisi konulan 54 olgu retrospektif olarak degerlendirildi. Ektopik gebeliklerin gorulme sikliginin mevsimsel dagilimi basvuru tarihleri baz alinarak incelendi. Hastalarin demografik verileri; yas, parite durumu, gebelik haftasi, human koryonik gonodotropin (β-HCG) duzeyleri, basvuru sikayetleri, ozgecmis bilgileri kaydedildi. Degiskenlerin tanimlayici istatistikleri ile methotreksat (MTX) tedavisinde basari oranlari ve basvuru tarihine gore mevsimsel dagilimlari IBM SPSS 22.0 paket programi ortaminda istatistiksel olarak analiz edildi. Ektopik gebelik oykusu olan hastalar ile cerrahiye yonlendirilen hastalar arasindaki iliski ki-kare testi ile analiz edildi. Sonuclar, istatistiksel olarak %95 guven araligi ve α=0.05 anlamlilik duzeyinde degerlendirildi. Bulgular: Ektopik gebelik olgularinin yas ortalamasi 33±4.6 idi. Tum olgular gelis sikayetlerine gore degerlendirildiginde, kasik agrisi (%40.7) ve sekonder amenore (%18.5) en sik gorulen sikayetler idi. Hastalar risk faktorleri acisindan degerlendirildiginde oykude en sik gecirilmis ektopik gebelik ve sezaryen operasyonu oldugu goruldu. Tani konuldugunda hastalarin %66.7’sinin (n=36) gebelik haftasi 4-6 hafta arasinda idi. Ayrica hastalarin %59.3’nun (n=32) MTX gunu s-HCG degerleri 5-1500 mlU/ml arasinda idi. Ortalama s-HCG degeri 609±412 mIU/ml idi. Hastalarin %85.2’ne (n=46) tek doz MTX yapildi ve kur saglandi. Hastalarin mevsimlere gore dagilimi incelendiginde, ektopik gebelik en sik %31.5 (n=17) oranla yaz mevsiminde goruldu. Sonuclar: Gunumuzde ektopik gebelik tanisinin erken konulmasi MTX tedavisini on plana cikarmaktadir. Calismamizda, klinigimizdeki MTX tedavi basari oranlarinin literaturle uyumlu oldugunu gosterildi. Ektopik gebeligin yaz aylarinda gorulme sikligi bize iklim ve mevsimsel degisikliklerin epidemiyolojide rol aldigini dusundurmektedir. Anahtar kelimeler: Ektopik gebelik; Methotreksat; Mevsimsel dagilim. ABSTRACT Purpose: The aim of this study is evaluate the demographic characteristics of the patients who diagnosed with ectopic pregnancy in our clinic, to evaluate the success rates of medical and surgical treatment and to analyze the distribution of the incidence of ectopic pregnancies by seasons. Material and Methods: 54 patients who diagnosed as ectopic pregnancy were admitted to Trabzon Medicalpark Hospital Gynecology and Obstetrics Clinic between the dates of January 2015 and January 2018 were analysed retrospectively. The seasonal distribution of the incidence of ectopic pregnancies was evaluated based on the application dates. The demographic dates of patients; age, parity status, gestational week, human chorionic gonodotropin (β-HCG) levels, application complaints, medical ilness history were recorded. The seasonal distribution of variables according to the application date and the success rates of methotrexate (MTX) were analyzed statistically in IBM SPSS 22.0 package program. The positive relationship between the patients with history of ectopic pregnancy and the referral to surgery was analyzed by chi-square test. Results were statistically evaluated with a 95% confidence interval and α = 0.05 significance level. Results: The mean age of the patients with ectopic pregnancy was 33 ± 4.6 years. When all the cases were evaluated according to the application complaints, inguinal pain (40.7%) and secondary amenorrhea (18.5%) were the most common complaints. When the patients were evaluated in the terms of risk factors, it was seen that ectopic pregnancy and cesarean section was the most common in the medical history. The patients of 66.7% (n = 36) percent were between 4 and 6 weeks of gestation at the time of diagnosis. In addition, 59.3% (n = 32) percent of the patients had s-HCG values on MTX day between 5-1500 mlU / ml. Average of the s-HCG value was 609 ± 412 mIU / ml. 85.2% (n = 46) of the patients were treated with MTX successfully. When the distribution of the patients according to the seasons was examined, the rates of ectopic pregnancy was most common in 31.5% (n = 17) in summer months. Conclusion: Currently, early diagnosis of ectopic pregnancy take MTX treatment stand out. In our study, the success rates of MTX treatment in our clinic were shown to be consistent with the literature. The incidence of ectopic pregnancy in summer months suggests that climate and seasonal changes act part in epidemiology. Key Words: Ectopic pregnancy; Methotrexate; Seasonal distribution.