Mertz H L, Yalcinkaya T M
Department of Obstetrics and Gynecology, West Virginia University, Charleston Division, USA.
J Reprod Med. 2001 Jan;46(1):29-33.
To determine if tubal rupture rates are decreased when a strict diagnostic algorithm is employed in the evaluation of women with suspected ectopic pregnancy as compared to individualized diagnostic methods.
Between 1994 and 1996, a group of investigators at Charleston Area Medical Center employed a strict diagnostic algorithm consisting of serum quantitative human chorionic gonadotropin (hCG) levels, progesterone levels, ultrasound and endometrial curettage in order to expedite diagnosis when ectopic pregnancy was suspected (group A patients). Other practitioners employed traditional criteria in similar clinical situations (group B patients). Medical records of patients diagnosed with ectopic pregnancy in this period were retrospectively reviewed. Demographic data, clinical and laboratory characteristics, and rate of tubal rupture were compared.
Sixty-one of 122 patients were diagnosed with ectopic pregnancy by strict criteria. These patients did not differ significantly from those evaluated by an individualized approach in regard to age, gravidity, parity or risk factors for ectopic pregnancy. Menstrual age, hCG levels and progesterone levels were similar as well. Group A patients had a median diagnostic interval of 2 days, with a range of 0-16. Group B patients had a median diagnostic interval of 8 days, with a range of 0-44 (P < .001). Of patients evaluated by this strict algorithm, 3.3% experienced rupture as compared to 23% of patients in group B (P < .001).
Use of a strict diagnostic algorithm in the evaluation of patients with suspected ectopic pregnancy resulted in decreased tubal rupture rates. Such an algorithm could be disseminated to all locations for triage of patients and use in a standardized manner. This practice could result in a reduction in loss of reproductive function and mortality secondary to ectopic pregnancy.
确定在评估疑似异位妊娠的女性时，采用严格的诊断算法与个体化诊断方法相比，输卵管破裂率是否降低。
1994年至1996年期间，查尔斯顿地区医疗中心的一组研究人员采用了一种严格的诊断算法，该算法包括血清定量人绒毛膜促性腺激素（hCG）水平、孕酮水平、超声检查和子宫内膜刮除术，以便在怀疑异位妊娠时加快诊断速度（A组患者）。其他从业者在类似临床情况下采用传统标准（B组患者）。对这一时期诊断为异位妊娠的患者的病历进行回顾性审查。比较人口统计学数据、临床和实验室特征以及输卵管破裂率。
122例患者中有61例通过严格标准诊断为异位妊娠。这些患者在年龄、妊娠次数、产次或异位妊娠危险因素方面与采用个体化方法评估的患者没有显著差异。月经龄、hCG水平和孕酮水平也相似。A组患者的中位诊断间隔为2天，范围为0至16天。B组患者的中位诊断间隔为8天，范围为0至44天（P < .001）。采用这种严格算法评估的患者中，3.3%发生了破裂，而B组患者为23%（P < .001）。
在评估疑似异位妊娠的患者时使用严格的诊断算法可降低输卵管破裂率。这样的算法可以推广到所有地方，用于对患者进行分诊并以标准化方式使用。这种做法可以减少异位妊娠导致的生殖功能丧失和死亡率。
