Ultra-sonografia transvaginal com doppler colorido para seleção das pacientes para tratamento conservador da gravidez ectópica íntegra Transvaginal ultrasonography with color doppler to select the patients for conservative treatment of unruptured ectopic pregnancy

Abstract

Objetivo: avaliar a eficiência da ultra-sonografia (US) transvaginal com Doppler colorido para a previsão dos resultados do tratamento sistêmico da gravidez ectópica íntegra com dose única de metotrexato. Pacientes e método: vinte pacientes com diagnóstico de gravidez ectópica foram incluídas no estudo. Os critérios de inclusão foram: estabilidade hemodinâmica, massa anexial com diâmetro Purpose: to evaluate the efficacy of color Doppler in the prediction of results of the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate. Methodology: twenty patients with a diagnosis of ectopic pregnancy were included in the study. The inclusion criteria were: hemodynamic stability, adnexal mass < 5.0 cm and decline of the titers of beta-hCG less than 15% in an interval of 24 h. The exclusion criteria were hepatic or renal disease and blood dyscrasias. Follow-up was by serial determinations of beta-hCG on days 4 and 7 after the beginning of the treatment, and weekly until the titers were negative. The patients were classified into 3 groups according to color Doppler: high risk (trophoblastic flow covering more than 2/3 of the mass), medium risk (when trophoblastic flow compromised 1/3 to 2/3 of tubal mass) and low risk (when trophoblastic flow covered less than 1/3 of the mass). Results: the success of the treatment with a single dose was 75% (15/20); when a second dose of MTX was used, the success rate was 85%. When comparing color Doppler with the results of the medical treatment, we had high risk in 4 patients and in all the treatment failed; medium and low risk in 16 patients, and in 15 the treatment was successful. Conclusion: color Doppler showing high risk indicated an unfavorable situation for the medical treatment with MTX, while medium and low risk in color doppler were favorable situations for the clinical treatment. However, these results should always be analyzed in association with the evolution curve of the beta-hCG titers.

Keywords

• Ultra-sonografia
• Dopplervelocimetria
• Gravidez ectópica
• Quimioterapia
• Ultrasound
• Dopplervelocimetry
• Ectopic pregnancy