Soriano David, Shrim Alon, Seidman Daniel S, Goldenberg Mordechai, Mashiach Shlomo, Oelsner Gabriel
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer 52621, Israel.
J Am Assoc Gynecol Laparosc. 2002 Aug;9(3):352-8. doi: 10.1016/s1074-3804(05)60416-1.
To compare the diagnosis and management of ectopic (EP) and heterotopic pregnancies (HP).
Retrospective comparative study (Canadian Task Force classification II-2).
University tertiary referral center for endoscopic surgery.
Twelve women with HP and 210 women with laparoscopically confirmed EP.
Laparoscopic treatment.
Among the 12 women with HP, all but 1 had received ovulation induction, 10 underwent in vitro fertilization-embryo transfer, and 1 conceived with clomiphen citrate. In the EP group 33 patients (15.7%) conceived spontaneously (p <0.05). Six women (50%) with HP had had previous pelvic surgery and three had a history of EP and salpingectomy. Four patients (33.4%) with HP and 29 (13.8%) with EP suffered from hypovolemic shock and required blood transfusion (p <0.05). Three of these four women with HP experienced physician and patient delays before admission. The sonographic diagnosis was correct in all women with HP and in 94.3% of women with EP. The median gestational age at diagnosis was 7.5 and 7.2 weeks for HP and EP, respectively. Six (50%) women with HP had evidence of fetal pulse in the ectopic gestation compared with 17 (8.1%) with EP (p <0.05). In addition, 66.7% and 24.7%, respectively, had ruptured tube (p <0.05). Mean +/- SD hemoperitoneum was 833.4 +/- 777 and 305 +/- 121 ml, respectively (p <0.05). Conversion to laparotomy was required in one (8.3%) and eight (3.8%) women, respectively (p <0.05). No major operative or postoperative maternal complications occurred in either group. Two women with HP had miscarriages, two have a continuing pregnancy, and eight delivered healthy newborns.
Women with HP are at significantly greater risk for hypovolemic shock and requiring blood transfusion than those with EP. The diagnosis of EP in cases of HP is difficult due to the presence of an intrauterine gestational sac and hyperstimulated ovaries. A greater level of suspicion may allow early laparoscopic intervention before life-threatening intraabdominal bleeding has occurred.
比较异位妊娠（EP）和子宫外孕（HP）的诊断与处理。
回顾性比较研究（加拿大工作组分类II-2）。
大学三级内镜手术转诊中心。
12例子宫外孕患者和210例经腹腔镜确诊的异位妊娠患者。
腹腔镜治疗。
在12例子宫外孕患者中，除1例之外均接受过促排卵治疗，10例接受过体外受精-胚胎移植，1例通过枸橼酸氯米芬受孕。在异位妊娠组中，33例患者（15.7%）自然受孕（p<0.05）。6例（50%）子宫外孕患者既往有盆腔手术史，3例有异位妊娠和输卵管切除术史。4例（33.4%）子宫外孕患者和29例（13.8%）异位妊娠患者发生低血容量休克并需要输血（p<0.05）。这4例子宫外孕患者中有3例在入院前出现了医生和患者的延误。所有子宫外孕患者及94.3%的异位妊娠患者超声诊断正确。子宫外孕和异位妊娠诊断时的中位孕周分别为7.5周和7.2周。6例（50%）子宫外孕患者的异位妊娠有胎心搏动，而异位妊娠患者中这一比例为17例（8.1%）（p<0.05）。此外，分别有66.7%和24.7%的患者输卵管破裂（p<0.05）。平均±标准差腹腔积血分别为833.4±777 ml和305±121 ml（p<0.05）。分别有1例（8.3%）子宫外孕患者和8例（3.8%）异位妊娠患者需要转为开腹手术（p<0.05）。两组均未发生重大手术或术后母体并发症。2例子宫外孕患者流产，2例继续妊娠，8例分娩健康新生儿。
与异位妊娠患者相比，子宫外孕患者发生低血容量休克和需要输血的风险显著更高。由于存在宫内妊娠囊和卵巢过度刺激，子宫外孕病例中异位妊娠的诊断较为困难。更高程度的怀疑可能有助于在危及生命的腹腔内出血发生之前进行早期腹腔镜干预。
