Gervaise A, de Tayrac R, Fernandez H
Service de Gynécologie-Obstétrique, Université Paris-Sud, Hôpital Antoine-Béclère (AP-HP), 157, rue de la Porte-de-Trivaux, 92141 Clamart Cedex.
J Gynecol Obstet Biol Reprod (Paris). 2003 Sep;32(5):417-9.
Define indications for endometrial biopsy and diagnostic hysteroscopy in ectopic pregnancy diagnosis. Define the indication of endometrial biopsy and diagnostic hysteroscopy in ectopic pregnancy diagnosis.
This prospective study included 15 women with a poorly localized pregnancy (ectopic or intrauterine localization not identified at ultrasound) who had an abnormal HCG curve and low progesteronemia.
In 8 patients, an empty cavity was identified at diagnostic hysteroscopy and the endometrial biopsy was negative. In 2 patients hysteroscopy was non-contributive (pregnancy and intra uterine device with blood in the cavity) and the endometrial biopsy was negative. In 3 patients who had an early abortion hysteroscopy and endometrial biopsy demonstrated villosities. Finally, in 2 patients who had an early abortion hysteroscopy identified villosities and endometrial biopsy was non-contributive. The sensitivity and specificity of hysteroscopy for the diagnosis of EP was 100% but the sensitivity of endometrial biopsy was 50% with a specificity of 100%.
If pregnancy cannot be correctly localized at ultrasonography, hysteroscopy appears to be better than endometrioal biopsy to discriminate between EP and early abortion.
明确子宫内膜活检和诊断性宫腔镜检查在异位妊娠诊断中的指征。明确子宫内膜活检和诊断性宫腔镜检查在异位妊娠诊断中的指征。
这项前瞻性研究纳入了15名妊娠部位不明确（超声检查未确定为异位妊娠或宫内妊娠）且人绒毛膜促性腺激素（HCG）曲线异常和孕酮水平低的女性。
8例患者在诊断性宫腔镜检查时发现宫腔空虚，子宫内膜活检为阴性。2例患者宫腔镜检查无诊断价值（妊娠合并宫内节育器且宫腔内有血液），子宫内膜活检为阴性。3例早期流产患者宫腔镜检查和子宫内膜活检显示有绒毛。最后，2例早期流产患者宫腔镜检查发现有绒毛，但子宫内膜活检无诊断价值。宫腔镜检查诊断异位妊娠的敏感性和特异性为100%，但子宫内膜活检的敏感性为50%，特异性为100%。
如果超声检查不能正确定位妊娠部位，宫腔镜检查在鉴别异位妊娠和早期流产方面似乎优于子宫内膜活检。
