Izvanmaternična trudnoća kao dijagnostički problem

master's thesis

• Title (english): Ectopic pregnancy - a diagnostic problem
• Author: Ana Benčić
• Mentor: Držislav Kalafatić (mentor)
• Committee member: Vladimir Banović (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Držislav Kalafatić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Izvanmaternična – ektopična trudnoća ozbiljno je stanje koje se javlja u oko 2% svih trudnoća i uzrok je 9% svih smrti povezanih s trudnoćom. U pacijentice reprodukcijske dobi, koja ima vaginalno krvarenje i abdominalnu bol, svakako treba isključiti ektopičnu trudnoću. Klasični trijas simptoma (amenoreja, vaginalno krvarenje i bol) javlja se u otprilike 50% pacijentica i nemoguće je postaviti sigurnu dijagnozu samo na temelju kliničke slike. Kombiniranom primjenom transvaginalnog ultrazvuka i serijskog mjerenja serumske razine β podjedinice humanog korionskog gonadotropina (β – hCG), smanjila se potreba za dijagnostičkom laparoskopijom. Osim toga, dijagnoza se postavlja sve ranije i točnije. Dijagnostički problem nastaje kad ultrazvučnim pregledom ne možemo odrediti lokalizaciju trudnoće. Tada se radi o „trudnoći nepoznate lokacije“ (engl. PUL – pregnancy of unknown location). Diskriminacijska razina β – hCG – a je ona razina prilikom koje bi se trebala vizualizirati normalna unutarmaternična tudnoća. Kliničar mora odrediti radi li se o ranoj normalnoj, patološkoj unutarmaterničnoj trudnoći ili ektopičnoj trudnoći. Danas bi se dijagnoza trebala postavljati na temelju vizualizacije ektopične trudnoće, radije nego na temelju neizravnog zaključivanja zbog nemogućnosti prikaza trudnoće unutar maternice. Serijskim mjerenjem serumske razine β – hCG – a bilježimo njegovu dinamiku porasta ili pada. U normalnoj trudnoći, razina se udvostruči svakih 48 sati. Odstupanje od takve krivulje sugerira patologiju trudnoće. Otprilike 20% pacijentica, prilikom inicijalne obrade, ima akutnu kliničku sliku s krvarenjem u trbušnu šupljinu. Kod tih žena odmah se pristupa operacijskom zahvatu. Iako se uvođenjem mjerenja razine β – hCG – a 80 –tih godina prošlog stoljeća i razvojem transvaginalnog ultrazvuka danas većina žena otkriva u stadiju prije rupture, još se uvijek dijagnoza ovog stanja donosi s određenim poteškoćama.

Abstract (english)

Ectopic pregnancy is a serious condition which affects around 2% of all pregnancies and is responsible for 9% of pregnancy-related deaths. When a patient of reproductive age presents with vaginal bleeding and abdominal pain, ectopic pregnancy should be ruled out. Classic symptoms (amenorrhea, vaginal bleeding and pain) occur in 50% of patients and it is impossible to diagnose ectopic pregnancy based only on clinical features. The combined use of transvaginal ultrasound and beta subunit of human chorionic gonadotropin (β – hCG), has reduced the use of laparoscopy as a diagnostic tool. Besides that, more patients are diagnosed more accurately and in the early stage. A diagnostic problem occurs when ultrasonography does not clearly identify the pregnancy location. That is called PUL – pregnancy of unknown location. β – hCG discriminatory level is the β – hCG value above which an intrauterine pregnancy should be visualized. It has to be determined whether the pregnancy is intrauterine (either viable of failing) or ectopic. Nowadays, the diagnosis should be based on the visualization of ectopic pregnancy, rather than diagnosis based on the absence of intrauterine pregnancy. Serial measurements of β – hCG allow us to monitor its dynamics. In normal intrauterine pregnancies β – hCG values increase by about 50% in 48 hours. Deviation from the normal curve can suggest abnormal pregnancy. Around 20% of patients present with acute onset of symptoms which indicate intraabdominal bleeding. These patients are candidates for emergency surgery. Even though β – hCG value measurements, introduced in 1980 –s and modern transvaginal ultrasound have increased number of patients diagnosed in early stage, there are still some diagnostic difficulties when it comes to ectopic pregnancy.

• Keywords: ektopična trudnoća; izvanmaternična trudnoća; dijagnoza; β – hCG; ultrazvuk
• Keywords (english): ectopic pregnancy; diagnosis; β – hCG; ultrasound
• Language: croatian
• URN:NBN: urn:nbn:hr:105:172509
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-12-20 11:02:53