Medikamentozno liječenje izvanmaterične trudnoće

master's thesis

• Title (english): Medical treatment of ectopic pregnancy
• Author: Jelena Gulišija
• Mentor: Miro Kasum (mentor)
• Committee member: Hrvoje Vrčić (predsjednik povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Committee member: Miro Kasum (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Cilj ove studije bio je prikazati uspješnost i pouzdanost liječenja izvanmaternične trudnoće sa metotreksatom (MTX) koristeći izvješća iz više svjetskih ginekološko-opstetričkih centara. Izvanmaternična trudnoća je svaka trudnoća koja se implantira izvan šupljine maternice. Učestalost izvanmaternične trudnoće je između 0,25-1,4% svih trudnoća. Radi se o ozbiljnom kliničkom problemu koji može rezultirati značajnim maternalnim morbiditetom i mortalitetom. To je po život opasno stanje koje zahtijeva rano otkrivanje i adekvatno liječenje. Izvanmaterničnu trudnoću možemo liječiti kiruruški, medikamentozno i ekspektativno. Cilj je izliječiti bolesnicu sa što manje nuspojava i komplikacija i dati što veću šansu za kasniju normalnu uterinu trudnoću, uvijek vodeći računa o omjeru cijene liječenja i učinkovitosti. U oko 25% rano dijagnosticiranih tubarnih trudnoća, nakon probira po određenim kriterijima, možemo primijeniti konzervativno liječenje medikamentima. U medikamentoznom liječenju izvanmaternične trudnoće istraživano je više medikamenata, a najviše se upotrebljava citostatik metotreksat (MTX), sam ili iznimno u kombinaciji s RU 486 (mifepriston). MTX bi trebalo primjenjivati u slučajevima kada je tubarna trudnoća u promjeru manja od 4 centimetra, u slučajevima kada se klinički ne osjeća bolnost, u situacijama kod bolesnica koje su više puta operirane (opasnost od priraslica!), kada u ultrazvučnoj obradi kod niskog, a naročito oscilirajućeg beta humanog korionskog gonadotropina (β-hCG) ne možemo locirati trudnoću (trudnoća nepoznate lokalizacije). Uspješnost liječenja je to veća što je β-hCG vrijednost na početku bila niža, kod razina većih od 1000-1500 IU/l na početku treba dobro promisliti hoćemo li uopće primijeniti MTX. Uspješnost je oko 88-93% za tubarne trudnoće bez ploda, a 70-80% za one sa živim plodom i visokim β-hCG-om. Primjenjuje se i kod perzistentnog trofoblasta nakon kirurškog liječenja. Nakon primjene MTX-a potreban je trajni nadzor bolesnice uz određivanje serumskog β-hCG-a i P4 kao i praćenje mogućih nuspojava od strane MTX-a.

Abstract (english)

The aim of this study was to discuss medical treatment of ectopic pregnancy (EP) focusing on methotrexate (MTX), by using reports from gynecological and obstetric centers. EP is every pregnancy located outside uterine cavity. The frequency of EP is between 0.25 to 1.4% of all pregnancies. It is a serious clinical problem that can result in significant maternal morbiditiy and mortality. This is life-threating condition that requires early detection and adequate treatment. EP can be managed surgically, medically and expectantly. The aim is to cure the patient with as few side effect and complications as possible and give the patient a chance for future natural uterine pregnancy, always taking into account the ratio of treatment cost and efficiency. In about 25% of early diagnosed tubal pregnancies, after screening by specific criteria, conservative medical treatment is applied. In the medical treatment of EP the most used drug is the cytostatic MTX, alone or, exceptionally, in combination with mifepristone. Indication for medical treatment with MTX are: tubal pregnancy in diameter less then 4 centimeters, in case when patient do not feel any pain, in situation where patient underwent any abdominal surgery (possible adhesions) and if it is not possible to detect pregnancy with low or oscillating beta human chorionic gonadotropin (β-hCG)-levels by ultrasound. The efficacy of the treatment is greater as the initial β-hCG-level was lower, at the initial β-hCG level of 1000-1500 IU/l we should think twice in order to use MTX. The successs is around 88-93% for tubal anembryonic pregnancy, and 70-80% for embryonic pregnancy and high β-hCG-level. It can be also given in cases of persistent trophoblast after surgical treatment. After administration of MTX, permanent monitoring of patient is required, consisting of serum β-hCG and progesterone (P4) determination as well as monitoring of possible side effect caused by MTX.

• Keywords: izvanmaternična trudnoća; metotreksat; medikamentozno liječenje; β-humani korionski gonadotropin
• Keywords (english): ectopic pregnancy; methotrexate; medical treatment; β-human chorionic gonadotropin
• Language: croatian
• URN:NBN: urn:nbn:hr:105:986115
• 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: 2017-11-14 11:11:07