Dart R G, Kaplan B, Varaklis K
Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA.
Ann Emerg Med. 1999 Mar;33(3):283-90. doi: 10.1016/s0196-0644(99)70364-1.
To identify historical and physical examination findings that are predictive of ectopic pregnancy (EP) in pregnant patients with abdominal pain or bleeding.
This study was conducted in an urban academic emergency department as a prospective observational study of consecutive patients from August 1, 1991, to August 31, 1992, who had abdominal pain or vaginal bleeding and a positive beta-human chorionic gonadotropin level. Patients were excluded if they had a diagnostic ultrasound during a previous visit, or if the uterine size was larger than 12 weeks by pelvic examination. Data were analyzed using chi2 with a P value less than. 05 identified as significant. Odds ratios were determined for significant variables. A classification and regression tree analysis was then performed using the predictive variables to derive a decision tree.
Four hundred forty-one patients were enrolled, 57 of whom (13%) had an EP. Factors by history that increased the risk of EP included pain that was described as moderate to severe, lateral, or sharp. Pain located in the midline decreased the risk of EP. A history of previous intrauterine device use, infertility, prior pelvic surgery, or tubal ligation were each found to be predictive. On physical examination, the presence of peritoneal signs, cervical motion tenderness, or lateral or bilateral abdominal or pelvic tenderness increased the risk of EP. A uterine size larger than 8 weeks by pelvic examination decreased the risk of EP. Combinations of predictive variables identified subsets of patients with either an increased or decreased frequency of EP, but in no case was a combination identified that would confirm or exclude this diagnosis with a high degree of certainty.
History and physical examination findings predictive of EP were identified. However, no constellation of findings could confirm or exclude this diagnosis with a high degree of reliability.
确定在有腹痛或出血的孕妇中，能够预测异位妊娠（EP）的病史和体格检查结果。
本研究在一家城市学术急诊科进行，是一项对1991年8月1日至1992年8月31日连续就诊的有腹痛或阴道出血且β-人绒毛膜促性腺激素水平呈阳性的患者进行的前瞻性观察研究。如果患者在之前的就诊中有诊断性超声检查，或者盆腔检查发现子宫大小大于12周，则将其排除。使用卡方检验分析数据，P值小于0.05被认为具有统计学意义。确定显著变量的比值比。然后使用预测变量进行分类和回归树分析，以得出决策树。
共纳入441例患者，其中57例（13%）为异位妊娠。病史中增加异位妊娠风险的因素包括描述为中度至重度、侧方或尖锐的疼痛。中线部位的疼痛降低了异位妊娠的风险。发现既往使用宫内节育器、不孕、既往盆腔手术或输卵管结扎史均具有预测性。体格检查时，出现腹膜刺激征、宫颈举痛或侧方或双侧腹部或盆腔压痛会增加异位妊娠的风险。盆腔检查发现子宫大小大于8周会降低异位妊娠的风险。预测变量的组合确定了异位妊娠发生率增加或降低的患者亚组，但在任何情况下，均未发现能高度确定地证实或排除该诊断的组合。
确定了可预测异位妊娠的病史和体格检查结果。然而，没有一组检查结果能高度可靠地证实或排除该诊断。
