Gebeliğin Atipik Yerleşimi: Ektopik Gebelik
Özet
Ektopik gebelik, blastokistin uterusun endometriyal kavitesi dışında herhangi bir yere yerleşmesidir. Amerika Birleşik Devletlerde, ektopik gebelik bildirilen tüm gebeliklerin yaklaşık %2'sini oluşturmaktadır (1). Günümüzün laboratuvar koşulları ve transvajinal ultrasonla birlikte ektopik gebeliğin hayati tehdit eden boyutlara ulaşması oldukça azalmıştır. Ancak hala özellikle normal gebelikle ayrımı zorlayıcı olabilmektedir (2).
Ektopik gebeliklerin yaklaşık %96’sı Fallop tüplerinde yerleşmektedir (3). Ektopik gebeliğin yönetimi yıllar geçtikçe oldukça değişmiştir (4).
Anahtar Kelimeler: ektopik gebelik, methotreksat, cerrahi tedavi
Konu Alanı: Tıp -> Tıp (diğer) -> Kadın Hastalıkları ve Doğum
1. Ectopic Pregnancy—United States, 1990-1992. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 1995;44:46-8. (Level II-2)
2. Kirk E, Ankum P, Jakab A, Clef NL, Ludwin A, Small R, Tellum T, Toyli M, Van den Bosch T, Jurkovic D. ESHRE Working Group on Ectopic Pregnancy. Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice. Hum Reprod Open 2020;2020:hoaa055.
3. Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002; 17:3224.
4. Alkatout I, Honemeyer U, Strauss A, et al. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 2013; 68:571.
5. Zane SB, Kieke BA Jr, Kendrick JS, Bruce C. Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Matern Child Health J 2002; 6:227.
6. Mann LM, Kreisel K, Llata E, et al. Trends in Ectopic Pregnancy Diagnoses in United States Emergency Departments, 2006-2013. Matern Child Health J 2020; 24:213.
7. Gaskins AJ, Missmer SA, Rich-Edwards JW, et al. Demographic, lifestyle, and reproductive risk factors for ectopic pregnancy. Fertil Steril 2018; 110:1328.
8. Creanga AA, Shapiro-Mendoza CK, Bish CL, et al. Trends in ectopic pregnancy mortality in the United States: 1980-2007. Obstet Gynecol 2011; 117:837.
9. Brim ACS, Barretto VRD, Reis-Oliveira JG, et al. Risk factors for ectopic pregnancy occurrence: Systematic review and meta-analysis. Int J Gynaecol Obstet 2025; 168:919.
10. Shaw JL, Wills GS, Lee KF, et al. Chlamydia trachomatis infection increases fallopian tube PROKR2 via TLR2 and NFκB activation resulting in a microenvironment predisposed to ectopic pregnancy. Am J Pathol 2011; 178:253.
11. Kamwendo F, Forslin L, Bodin L, Danielsson D. Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sex Transm Infect 2000; 76:28.
12. Bouyer J, Coste J, Shojaei T, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol 2003; 157:185.
13. Perkins KM, Boulet SL, Kissin DM, et al. Risk of ectopic pregnancy associated with assisted reproductive technology in the United States, 2001-2011. Obstet Gynecol 2015; 125:70.
14. Schultheis P, Montoya MN, Zhao Q, et al. Contraception and ectopic pregnancy risk: a prospective observational analysis. Am J Obstet Gynecol 2021; 224:228.
15. Li C, Zhao WH, Meng CX, et al. Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study. PLoS One 2014; 9:e115031.
16. Raine-Bennett T, Fassett MJ, Chandra M, et al. Ectopic pregnancy prevention: Further evidence of benefits of prescription contraceptives. Contraception 2022; 105:19.
17. Rogne T, Liew Z, Hernáez Á, et al. Modifiable risk factors for ectopic pregnancy: a Mendelian randomization study. Am J Obstet Gynecol 2022; 227:339.
18. Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 1999; 72:207.
19. Cheng PJ, Chueh HY, Qiu JT. Heterotopic pregnancy in a natural conception cycle presenting as hematometra. Obstet Gynecol 2004; 104:1195.
20. Connolly A, Ryan DH, Stuebe AM, Wolfe HM. Reevaluation of discriminatory and threshold levels for serum β-hCG in early pregnancy. Obstet Gynecol 2013; 121:65.
21. Barnhart KT, Guo W, Cary MS, et al. Differences in Serum Human Chorionic Gonadotropin Rise in Early Pregnancy by Race and Value at Presentation. Obstet Gynecol 2016; 128:504.
22. Condous G, Kirk E, Lu C, et al. Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location. Ultrasound Obstet Gynecol 2005; 26:770.
23. Condous G, Kirk E, Lu C, et al. There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location. Hum Reprod 2006; 21:2706.
24. Ko JK, Cheung VY. Time to revisit the human chorionic gonadotropin discriminatory level in the management of pregnancy of unknown location. J Ultrasound Med 2014; 33:465.
25. Hassiakos D, Bakas P, Pistofidis G, Creatsas G. Heterotopic pregnancy at 16 weeks of gestation after in-vitro fertilization and embryo transfer. Arch Gynecol Obstet 2002; 266:124.
26. Ackerman TE, Levi CS, Dashefsky SM, et al. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 1993; 189:83.
27. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131(3):e91-e103.
28. Elson J, Tailor A, Banerjee S, et al. Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. Ultrasound Obstet Gynecol 23:552, 2004.
29. Trio D, Strobelt N, Picciolo C, et al. Prognostic factors for successful expectant management of ectopic pregnancy. Fertil Steril 63:469, 1995.
30. Dooley WM, Farren J, De Braud LV, et al. Interpregnancy interval and risk of recurrence following tubal ectopic pregnancy: retrospective cohort study from UK tertiary center. Ultrasound Obstet Gynecol 2025; 66:89.
31. Tulandi T. Ectopic pregnancy: Expectant management of tubal pregnancy. In: UpToDate, Schreiber CA, Chakrabarti A, eds. UpToDate [Internet]. Waltham, MA: UpToDate Inc.; literature review current through Jun 2026.
32. Lipscomb GH, McCord ML, Stovall TG, et al. Predictors of success of methotrexate in women with tubal ectopic pregnancies. N Englad J Med 341:1974, 1999.
33. Goldin A, Venditti JM, Kline I, Mantel N. Eradication of leukaemic cells (L1210) by methotrexate and methotrexate plus citrovorum factor. Nature 1966; 212:1548.
34. Hoyos LR, Malik M, Najjar M, et al. Morbid obesity and outcome of ectopic pregnancy following capped single-dose regimen methotrexate. Arch Gynecol Obstet 2017; 295:375.
35. Natale A, Candiani M, Barbieri M, et al. Pre- and post-treatment patterns of human chorionic gonadotropin for early detection of persistence after a single dose of methotrexate for ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 2004; 117:87.
36. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol 2003; 101:778.
37. Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 2013; 100:638.
38. Rosh B, Hadad J, Gronich N. Timing of conception after methotrexate and subsequent pregnancy outcomes: A retrospective cohort study. Int J Gynaecol Obstet 2026; 174:1061.
39. Strauss JF, Williams CJ. The ovarian life cycle. In: Yen and Jaffe's Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management, 5th ed, Strauss JF, Barbieri RL (Eds), Elsevier Saunders, Philadelphia 2004. p.213.
40. Svirsky R, Rozovski U, Vaknin Z, et al. The safety of conception occurring shortly after methotrexate treatment of an ectopic pregnancy. Reprod Toxicol 2009; 27:85.
41. National Institute for Health and Care Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE guideline NG126. London: NICE; 2019 [updated 2026 Jun 17].
42. Tulandi T, Al Jaroudi D. İnterstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol 103:47, 2004.
43. May B, Friedlander H, Schust D, Bollig KJ. Pregnancies at the uterotubal junction: a review of terminology (interstitial, cornual, and angular) and recommendations for management. Reprod Sci. 2024;31(9):2576-2587.
44. Ushakov FB, Elchalal U, Aceman PJ, et al. Cervical pregnancy: past and future. Obstet Gynecol Surv 52:45, 1997.
45. Pisarka MD, Carson SA. Incidence and risk factors for ectopic pregnancy. Clin Obstet Gynecol 42:2, 1999.
46. Current trends in the treatment of cervical pregnancy: a narrative review. Medicina (Kaunas). 2025;61(11):2072. doi:10.3390/medicina61112072.
47. Elsayed S, Farah N, Anglim M. Heterotopic pregnancy: case series and review of diagnosis and management. Case Rep Obstet Gynecol. 2023;2023:2124191.
48. Agrawal M, Reddy LS, Patel D, Jyotsna G, Patel A. Fetal reduction by potassium chloride infusion in unruptured heterotopic pregnancy: a comprehensive review. Cureus. 2024;16(2):e53618.
49. Society for Maternal-Fetal Medicine; Miller R, Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine Consult Series #63: Cesarean scar ectopic pregnancy. Am J Obstet Gynecol. 2022;227(3):B9-B19.