Gracia C R, Barnhart K T
Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 10104, USA.
Obstet Gynecol. 2001 Mar;97(3):464-70. doi: 10.1016/s0029-7844(00)01159-5.
To compare six published methods of diagnosing ectopic pregnancy.
Decision analysis compared six diagnostic algorithms involving combinations of clinical examination, transvaginal ultrasound, serum progesterone, serum hCG, and D&C. The population was composed of hemodynamically stable women who presented to a tertiary care university emergency department with abdominal pain or bleeding in their first trimesters. Outcome measures included number of missed ectopic pregnancies, potentially interrupted intrauterine pregnancies, surgical and diagnostic procedures, time until diagnosis, and cost.
Ultrasound followed by serum hCG in women with nondiagnostic scans yielded the most favorable outcomes; no ectopic pregnancy was missed, only 1% of all potential intrauterine pregnancies were interrupted, and time to diagnosis averaged 1.46 days. Quantitative hCG measurement followed by ultrasound only in women with hCG levels above the discriminatory zone was optimal if sensitivity of ultrasound to diagnose intrauterine pregnancy was less than 93%. Serum progesterone measurement was not favored because it was associated with missed ectopic pregnancies (2.6%).
Given the current accuracy of tests for diagnosing ectopic pregnancy, algorithms using a combination of ultrasound and hCG resulted in the best outcomes. Ultrasound as the first step was the most efficient and accurate method of diagnosing ectopic pregnancies.
比较已发表的六种诊断异位妊娠的方法。
决策分析比较了六种诊断算法，这些算法涉及临床检查、经阴道超声、血清孕酮、血清人绒毛膜促性腺激素（hCG）和刮宫术的组合。研究人群为血流动力学稳定的女性，她们在孕早期因腹痛或出血就诊于一所三级护理大学急诊科。结局指标包括漏诊的异位妊娠数量、可能被中断的宫内妊娠、手术和诊断程序、诊断所需时间以及成本。
对于超声检查无诊断结果的女性，先进行超声检查再检测血清hCG产生了最有利的结果；没有漏诊异位妊娠，所有可能的宫内妊娠中只有1%被中断，诊断平均时间为1.46天。如果超声诊断宫内妊娠的敏感性低于93%，对于hCG水平高于鉴别阈值的女性，先进行定量hCG检测再进行超声检查是最佳选择。血清孕酮检测不太可取，因为它与2.6%的异位妊娠漏诊有关。
鉴于目前诊断异位妊娠检测方法的准确性，结合超声和hCG的算法产生了最佳结果。超声作为第一步是诊断异位妊娠最有效和准确的方法。
