Ektopik Gebelik (Dış Gebelik) - www.jinekolojivegebelik.com

EKTOP İK GEBELİKTE GÜNCEL YAKLAŞIMLAR

İçerik: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tanım & Epidemioloji: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Patoloji: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pato genez (Embryo ile ilgili): ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Risk faktörleri ,[object Object],[object Object],[object Object]

Yüksek Risk Faktörleri: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Yüksek Risk Faktörleri(2): ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Orta Risk Faktörleri ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Düşük Risk Faktörleri: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Yerleşim Yerleri: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Semptomlar: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Muayene Bulguları: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ektopik Gebelikte Tanı: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

β - h CG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Progesteron ,[object Object],[object Object],[object Object],[object Object]

USG Bulgular ı: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

USG Bulguları (Adneksler): ,[object Object],[object Object],[object Object],[object Object]

USG Bulguları : ,[object Object],[object Object],[object Object]

EKTOPİK GEBELİK USG BOYUT ve SERUM BİOKİMYASI İLİŞKİSİ Ultrasound Obstet Gynecol. Nov. 2006

Dilatasyon&Küretaj ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Kuldosentez ,[object Object],[object Object],[object Object],[object Object]

Laparoskopi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ayırıcı Tanı: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tedavi Beklentisel Yakla şım Medikal Tedavi Cerrahi Tedavi

Beklentisel Yaklaşım: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Beklentisel Yaklaşım: ,[object Object],[object Object]

Avantajları & Dezavantajları: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medikal Tedavi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medikal Tedavi: Aktif pulmoner hastalık peptik ülser, ilaca hipersensitivite, sistemik hastalıklar İmmün yetmezlik Emziren kadınlar Fetal kardiak aktivite Hasta uyumsuzluğu Ektopik gebelik kitlesi büyük ( > 4 cm) Hemodinamik olarak instabil Yüksek β hCG ( β hCG > 5000) Kontraendikasyonlar: Relatif Kontraendikasyonlar:

Tek Doz Tedavi Protokolü: ,[object Object],hCG, CBC, KCFT 7 hCG 4 hCG IM Mtx 50 mg/m ² 1 hCG, CBC, KCFT, Üre, Kre, Elektrolitler 0 Tetkik: Uygulanan: Gün:

Doz Tekrarı: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lipscomb, Am J Obstet Gynecol, 1998 Dilbaz, J Reprod Med, 2006

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tek Doz Uygulamasında Başarı veya Başarısızlığı Öngören Faktörler Kirk E et al. Current Opinion in Obstetrics and Gynecology, 2006

Tedavi Başarısını Etkileyen Faktörler ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dilbaz S ,J Reprod Med 2006

Tedavi Başarısını Etkileyen Faktörler ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tek Doz Uygulaması ,[object Object],Lipscomb GH et al. N Engl J Med 1999

Çoklu Doz Tedavi Protokolü: ,[object Object],[object Object],[object Object],hCG Folinik asit 0,1 mg/kg 2,4,6,8 hCG IM Mtx 1 mg/kg 1,3,5,7 hCG, CBC, KCFT, Üre, Kre, Elektrolitler - 0 Tetkik: Uygulanan: Gün:

Tek ve Çoklu Doz MTX Tedavi Protokolu ACOG practice bulletin 2003

Tek Doz vs Çoklu Doz ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tek Doz vs Çoklu Doz ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Fertil Steril 2007

Monitörizasyon : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Monitörizasyon : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medikal Tedavi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medikal Tedavi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medikal Tedavi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cerrahi Tedavi: Cerrahi Tedavi Konservatif Tedavi Radikal Cerrahi ,[object Object],[object Object],[object Object],[object Object]

Cerrahi Tedavi Endikasyonları: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cerrahi Tedavi: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Salpingostomi vs salpingotomi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Radikal Cerrahi Tedavi: ,[object Object],[object Object],[object Object],[object Object]

Radikal Cerrahi Tedavi: Laparoskopik Salpenjektomi

Radikal Cerrahi Tedavi: Elektrocerrahi kullanılarak yapılan Laparoskopik Salpenjektomi

Radikal Cerrahi Tedavi: Vasküler Anatomi

Cerrahi Tedavi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cerrahi Tedavi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Salpenjektomi vs Salpingostomi: ,[object Object],[object Object],[object Object],[object Object]

Laparoskopi vs Laparotomi: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

L/S Salpingostomi vs LPT ile Salpingostomi ,[object Object],[object Object],[object Object],[object Object]

Persiste Ektopik Gebelik: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medikal Tedavi vs Cerrahi Tedavi ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hajenius ,Cochrane Database Syst Rev 2007

Servikal Gebelik: ,[object Object],[object Object],[object Object],[object Object]

Servikal Gebelik: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Servikal Gebelik: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

İnterstisyel Gebelik ,[object Object],[object Object],[object Object],[object Object]

METHOTREXATE TEDAVİSİ Kornual Gebelik ,[object Object],[object Object],[object Object],[object Object], Dilbaz S et al. J Reprod Med 2005

Abdominal Gebelik ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ovaryen Gebelik ,[object Object],[object Object],[object Object],[object Object]

Ektopik gebelik tanısal akış şeması Hemodinamik boz.(+) Hemodinamik boz.(-) Gebelik lokasyonu ektopik Hemodinamik boz.(-) Gebelik lokasyonu bilinmiyor Cerrahi ted. ve stabilizasyon Cerrahi veya medikal ted. Seri USG ve hCG izlemi non-viable gebelik viable gebelik EG IUP Cerrahi / Medikal ted. D&C Villus (+) Villus (-) Spontan abortus EG Cerrahi/Medikal ted.

Sonuç: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sonuç: ,[object Object],[object Object],[object Object],[object Object]

[object Object],Hayatımda gördüğüm en ilginç ektopik gebelik vakası

Ektopik Gebelik (Dış Gebelik) - www.jinekolojivegebelik.com

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