Murray Heather, Baakdah Hanadi, Bardell Trevor, Tulandi Togas
Department of Emergency Medicine, Queen's University, Kingston, Ont.
CMAJ. 2005 Oct 11;173(8):905-12. doi: 10.1503/cmaj.050222.
Ectopic pregnancy is a life- and fertility-threatening condition that is commonly seen in Canadian emergency departments. Increases in the availability and use of hormonal markers, coupled with advances in formal and emergency ultrasonography have changed the diagnostic approach to the patient in the emergency department with first-trimester bleeding or pain. Ultrasonography should be the initial investigation for symptomatic women in their first trimester; when the results are indeterminate, the serum beta human chorionic gonadotropin (beta-hCG) concentration should be measured. Serial measurement of beta-hCG and progesterone concentrations may be useful when the diagnosis remains unclear. Advances in surgical and medical therapy for ectopic pregnancy have allowed the proliferation of minimally invasive or noninvasive treatment. Guidelines for laparoscopy and for methotrexate therapy are provided.
异位妊娠是一种危及生命和生育能力的病症，在加拿大急诊科较为常见。激素标志物的可及性和使用的增加，再加上正规超声检查和急诊超声检查的进展，改变了急诊科对孕早期出血或疼痛患者的诊断方法。超声检查应作为孕早期有症状女性的初步检查；当结果不明确时，应测量血清β-人绒毛膜促性腺激素（β-hCG）浓度。当诊断仍不明确时，连续测量β-hCG和孕酮浓度可能有用。异位妊娠的手术和药物治疗进展使得微创或无创治疗得以广泛应用。本文提供了腹腔镜检查和甲氨蝶呤治疗的指南。
