en مقایسه روش های درمان حاملگی خارج از رحم: یک مطالعه مقطعی Pregnancy Health Original Article Original Article <div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">حاملگی خارج از رحم یکی از دلایل مهم در مرگ و میر مادران در سه ماهه اول بارداری می&shy;باشد.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در این مطالعه به بررسی چهار روش درمان حاملگی خارج از رحم که شامل درمان تک&shy;دوز و دو&shy;دوز متوتروکسات، جراحی و درمان انتظاری است&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; می&shy;پردازیم.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مواد و روش&shy;ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در این مطالعه</span></span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مقطعی، مشخصات بالینی مربوط به 365 بیمار مراجعه&shy;کننده به بیمارستان&shy;های وابسته به دانشگاه علوم پزشکی شیراز با محدوده سنی 44-15 سال و در بازه زمانی اسفند 1395 تا 1397، که حاملگی خارج از رحم برای آنها تشخیص داده شده بود مورد مطالعه قرار گرفت. نمودار راک به منظور پیش&shy;بینی نقطه برش برای سایز توده و میزان هورمون </span></span><span dir="LTR" style="font-size:10.0pt">&beta;-hCG</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> به منظور مقایسه روش جراحی و درمان دارویی دو دوز رسم گردید.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">بیشترین توده&shy;ها در قسمت آدنکس قرار گرفته بودند. طبق نتایج به دست آمده از نمودار راک، روش جراحی برای افرادی که دارای سایز توده&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;</span></span><span dir="LTR" style="font-size:10.0pt">mm</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> 50/34</span></span><span dir="LTR" style="font-size:10.0pt">> </span><span style="font-size:11.0pt"><span b="" mitra="" style="font-family:">&nbsp;و </span></span><span dir="LTR" style="font-size:10.0pt">&nbsp;mIU/ml</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">6419 < </span></span><span dir="LTR" style="font-size:10.0pt">&beta;-hCG</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> باشند، به عنوان بهترین روش محسوب می&shy;شود. میزان </span></span><span dir="LTR" style="font-size:10.0pt">&beta;-hCG</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> در گروه متوتروکسات تک</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">دوز با درمان موفق به صورت معنی</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">دار کمتر از درمان تک</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">دوز ناموفق بود (02/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">). در مقایسه درمان متوتروکسات تک&shy;دوز و دو&shy;دوز، درمان تک&shy;دوز با داشتن میزان موفقیت بالاتر و طول بستری کوتاه&shy;تر بیماران، به عنوان درمان موثرتری نسبت به درمان دو&shy;دوز مورد توجه قرار گرفت.</span></span><span lang="FA" style="font-size:11.0pt"></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتیجه&shy;گیری:</span></span></b> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">جراحی به عنوان خط اول درمان برای بیماران با میزان </span></span><span dir="LTR" style="font-size:10.0pt">&beta;-hCG</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> بالا و سایز توده بزرگ پیشنهاد می&shy;گردد. در این مطالعه، درمان متوتروکسات تک&shy;دوز به دلیل میزان موفقیت بالاتر و زمان بستری کوتاه&shy;تر، درمان مناسب&shy;تری نسبت به درمان دو&shy;دوز معرفی می&shy;گردد. کارآزمایی‌های بالینی تصادفی‌سازی‌ شده بیشتر با حجم نمونه بزرگ&shy;تر برای تأیید نتایج فعلی توصیه می‌شود.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:10.0pt"></span></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:16pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Arial,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Background:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> Ectopic pregnancy (EP) is one of the major causes of maternal mortality during the first trimester of pregnancy. </span></span></span></span></span></span><br> <span style="font-size:16pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Arial,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Objective: </span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Four treatment methods for EP including single-dose methotrexate (SD-MTX), double-dose methotrexate, expectant and surgical management were considered.</span></span></span></span></span></span><br> <span style="font-size:16pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Arial,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Materials and Methods:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> In this cross-sectional study, the clinical characteristics of 365 women aged 15-44 yr who had been diagnosed with EP were reviewed from March 2017 to March 2019 in hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Receiver operating characteristics curves were plotted to determine the cut-off points for size of ectopic mass and <a name="_Hlk50371014">beta-human chorionic gonadotropin (&beta;</a>-hCG) that suitably discriminated between double-dose methotrexate and surgery management. </span></span></span></span></span></span><br> <span style="font-size:16pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Arial,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Results:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> The most common site of EP was adnexa. According to the receiver operating characteristics analysis, surgery was the best plan for the women with an ectopic mass > 34.50 mm in diameter or with an initial &beta;-hCG level > 6419 mIU/ml. The &beta;-hCG levels in the women successfully treated with SD-MTX were significantly lower than in those with failed treatment (p = 0.02). The SD-MTX group had a higher success rate and significantly shorter duration of hospitalization, and so this was a more effective medical treatment in comparison with the DD protocol. </span></span></span></span></span></span><br> <span style="font-size:16pt"><span style="line-height:normal"><span style="unicode-bidi:embed"><span sans-serif="" style="font-family:Arial,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Conclusion:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> Surgery is proposed as the best option for the cases with large ectopic mass<a name="_Hlk43642063"> or high </a>&beta;-hCG level. SD-MTX had a higher success rate and shorter hospital stay than the DD protocol, and so was found to be an efficient and safe alternative. Further randomized clinical trials with larger sample sizes are recommended to validate the current results.</span></span></span></span></span></span></div> حاملگی خارج از رحم, متوتروکسات, β-hCG, درمان. Ectopic pregnancy, Methotrexate, β-hCG, Treatment. 177 184 http://ijrm.ir/browse.php?a_code=A-10-1402-2&slc_lang=en&sid=1 Zahra Shiravani shiravanizahra63@gmail.com 0000-0001-5796-2954 No Gynecology Oncology Division, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran. Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Sana Atbaei sanaatbaei@icloud.com 0000-0001-7973-0396 No Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Bahia Namavar Jahromi namavarb@sums.ac.ir 0000-0002-7839-9627 No Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Mojgan Hajisafari Tafti dr.mhajisafari@gmail.com 0000-0001-7352-9341 No Department of Obstetrics and Gynecology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Shaghayegh Moradi Alamdarloo shaghayeghmoradi84@gmail.com 0000-0002-4064-4906 No Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Tahereh Poordast ta.poordast@yahoo.com 0000-0003-0151-978X No Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Adel Noori Adelnoori_kh@yahoo.com 0000-0002-5562-8845 No Shiraz University of Medical Sciences, Shiraz, Iran. Sedighe Forouhari foruharis@sums.ac 0000-0002-5652-7579 No Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Soudabeh Sabetian soudabehsabet@gmail.com 0000-0002-4215-9680 Yes Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.