Ektopik gebelik tedavisi sonrası fertilite oranlarının değerlendirilmesi

Objective: Evaluation of fertility rates of ectopic pregnancy after medical treatment, surgical treatment and expectan management Patients and Methods: In our study, the results of the treatments applied to the patients diagnosed with ectopic pregnancy who applied to the Obstetrics and Gynecology outpatient clinics of Ondokuz Mayıs University Faculty of Medicine between January/2015-December/2020 and were consulted from the emergency service, and their subsequent pregnancy status were evaluated. Age, demographic characteristics, b-hCG values, frequency of conditions that may be ectopic risk factors in the population, treatment success, recurrence of ectopic pregnancy, and spontaneous intrauterine pregnancy variables in subsequent pregnancies were reached and their relationship with their fertility was evaluated. The data were compared statistically and the results were evaluated with statistical analysis. Results: Patients with a diagnosis of ectopic pregnancy, aged between 18-45 years, between January 2015 and December 2020 were included in the study.314 patients were divided into three groups as medical treatment, surgical treatment and expectant approach. 17 patients (5.4%) in the expectant approach group , 80 patients (25.5%) in the medical treatment group and 217 patients (69.1%) in the surgical approach group.The mean age of the patients was 27.9, 28.53 and 28.58 years in the expectant approach, medical treatment and surgical treatment groups, respectively.The ectopic risk factors of the patients, such as smoking history, miscarriage, curettage, pelvic infection, previous use of contraceptives, intrauterine device use, and previous abdominal surgery were questioned. In terms of these risk factors, no difference was observed in the groups that could cause a difference in fertility outcome.The most common reason for admission in patients who underwent surgical treatment was vaginal bleeding, and menstrual delay in the group given medical treatment and expectant treatment. The success rate of surgical treatment was 98%, the success rate of medical treatment was 72%, and the success rate of expectant approach was 94%. Recurrence of ectopic pregnancy after treatment; ıt was found 11% in expectan approach, 26.3% in medical treatment and 16% in surgical treatment. There was no statistical difference between the groups in terms of ectopic recurrence. As a result of the study, spontaneous intrauterine pregnancy rate was observed in the lowest surgical treatment group with 27.6%.Spontaneous intrauterine pregnancy rates were 40% and 52.9%, respectively, in the groups that underwent this approach. There was a difference between the groups in terms of fertility rates (p=0.02<0.05) Discussion and Conclusion: There was no difference in terms of treatment success between medical treatment of ectopic pregnancy and management with expectant approach. Medical treatment and expectant approach had similar results in terms of fertility.However, the fertility rate was found to be lower in surgical treatment compared to other methods Keywords: Ectopic Pregnancy, Methotrexate, Salpingectomy, Serum b-hCG, Fertility, Expectan management