Condous George, Okaro Emeka, Bourne Tom
Royal North Shore Hospital, University of Sydney, Australia.
Curr Opin Obstet Gynecol. 2005 Dec;17(6):568-73. doi: 10.1097/01.gco.0000191515.07019.cb.
This review discusses various aspects of the management of women with pregnancies of unknown location.
The prevalence of pregnancies of unknown location is dependent on the quality of scanning for a given early-pregnancy unit. The higher the quality of scanning, the better the detection of ectopic pregnancy using ultrasound as a single diagnostic test, which in turn results in fewer women being classified with a pregnancy of unknown location. Varying the discriminatory zone does not significantly improve the detection of ectopic pregnancies in a pregnancy of unknown location population. A single serum human chorionic gonadotrophin, when used in a specialized transvaginal scanning unit, is not only potentially falsely reassuring but also unhelpful in excluding the presence of an ectopic pregnancy. A single-visit approach has also been shown to be ineffective. The vast majority of women with a pregnancy of unknown location are at low-risk for ectopic pregnancy. Traditional strategies are capable of detecting the failing pregnancies of unknown location and intra-uterine pregnancies within a pregnancy of unknown location population, but they lack sensitivity for detecting ectopic pregnancies. This justifies the recent development and use of mathematical modelling techniques to predict ectopic pregnancies in the pregnancies of unknown location population.
New mathematical models have been developed to predict the outcome of pregnancies of unknown location; however, prospective studies are needed to assess the reproducibility of these models in different centres on different populations. Hopefully such models will enable the clinician to correctly classify pregnancies of unknown location earlier, in turn reducing the number of follow-up visits.
本综述讨论了对妊娠部位不明的女性进行管理的各个方面。
妊娠部位不明的发生率取决于特定早期妊娠单位的超声检查质量。超声检查质量越高，作为单一诊断测试检测异位妊娠的效果越好，进而使被归类为妊娠部位不明的女性数量减少。改变鉴别阈值并不能显著提高在妊娠部位不明人群中检测异位妊娠的能力。在专门的经阴道超声检查单位使用单次血清人绒毛膜促性腺激素，不仅可能会给出错误的安心结果，而且无助于排除异位妊娠的存在。单次就诊方法也已被证明无效。绝大多数妊娠部位不明的女性异位妊娠风险较低。传统策略能够在妊娠部位不明人群中检测出失败的妊娠部位不明妊娠和宫内妊娠，但它们对检测异位妊娠缺乏敏感性。这证明了最近开发和使用数学建模技术来预测妊娠部位不明人群中的异位妊娠是合理的。
已经开发出新的数学模型来预测妊娠部位不明妊娠的结局；然而，需要进行前瞻性研究来评估这些模型在不同中心针对不同人群的可重复性。希望这样的模型能够使临床医生更早地正确分类妊娠部位不明的妊娠，从而减少随访次数。
