目的:为了评估发病率,风险因素,和在三级护理中心治疗的非输卵管异位妊娠(NTEP)的治疗结果。
方法:将2014年至2019年收治的110例NTEP患者纳入回顾性研究。研究队列根据妊娠定位分为6组:87例剖宫产瘢痕妊娠(CSP),7次卵巢妊娠,6间质性妊娠,4次基本角怀孕,4次腹部妊娠,和2次宫颈妊娠。一名妇女拒绝了所有治疗方式。人口特征,治疗方式,并对每组的结局进行评价。
结果:在研究队列中,1名(0.9%)妇女接受期待管理。29名(26.3%)妇女接受了甲氨蝶呤(MTX)治疗。17名(15.4%)女性接受了手术,63名(57.2%)女性接受了手动真空抽吸术(MVA)。一名妇女拒绝了所有治疗方式。尽管70.1%(n=61)的CSP用MVA固化,除MVA外,其中24.1%(n=21)接受单剂量MTX方案治疗。平均孕囊大小较高(33,9±12,96mmvs.17,34±9,87mm),平均孕周较高(8,43±1,16wvs.6,66±1,49w),胎儿心跳(FHB)的存在(90.5%vs.26,2%)和盆腔炎症性疾病(PID)的病史(38.1%与在MVA治疗失败的CSP中发现了6,6%)(p<0.05)。
结论:NTEPs的管理应根据临床和超声检查结果进行个体化。异位妊娠肿块的大小,孕周,FHB的存在,PID病史是CSP病例MVA失败的预测因素。
OBJECTIVE: To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center.
METHODS: A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated.
RESULTS: In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic ınflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05).
CONCLUSIONS: The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.