不同鉴别区间对妊娠部位不明女性异位妊娠预测的诊断准确性

Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location.

作者信息

Condous G, Kirk E, Lu C, Van Huffel S, Gevaert O, De Moor B, De Smet F, Timmerman D, Bourne T

机构信息

Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, Department of Obstetrics & Gynaecology, St George's Hospital Medical School, London, UK.

出版信息

Ultrasound Obstet Gynecol. 2005 Dec;26(7):770-5. doi: 10.1002/uog.2636.

DOI:10.1002/uog.2636

PMID:16308901

Abstract

OBJECTIVES

Various serum human chorionic gonadotropin (hCG) discriminatory zones are currently used for evaluating the likelihood of an ectopic pregnancy in women classified as having a pregnancy of unknown location (PUL) following a transvaginal ultrasound examination. We evaluated the diagnostic accuracy of discriminatory zones for serum hCG levels of > 1000 IU/L, 1500 IU/L and 2000 IU/L for the detection of ectopic pregnancy in such women.

METHODS

This was a prospective observational study of women who were assessed in a specialized transvaginal scanning unit. All women with a PUL had serum hCG measured at presentation. Expectant management of PULs was adopted. These women were followed up with transvaginal ultrasound, monitoring of serum hormone levels and laparoscopy until a final diagnosis was established: a failing PUL, an intrauterine pregnancy (IUP), an ectopic pregnancy or a persisting PUL. The persisting PULs probably represented ectopic pregnancies which had been missed on ultrasound and these were incorporated into the ectopic pregnancy group. Three different discriminatory zones (1000 IU/L, 1500 IU/L and 2000 IU/L) were evaluated for predicting ectopic pregnancy in this PUL population.

RESULTS

A total of 5544 consecutive women presented to the early pregnancy unit between 25 June 2001 and 14 April 2003. Of these, 569 (10.3%) women were classified as having a PUL, 42 of which were lost to follow up. Of the 527 (9.5%) cases with PUL analyzed, there were 300 (56.9%) failing PULs, 181 (34.3%) IUPs and 46 (8.7%) ectopic pregnancies. Overall, 74.6% were symptomatic and 25.4% were asymptomatic (P = 8.825E-07). The sensitivity and specificity of an hCG level of > 1000 IU/L to detect ectopic pregnancy were 21.7% (10/46) and 87.3% (420/481), respectively; for an hCG level of > 1500 IU/L these values were 15.2% (7/46) and 93.4% (449/481), respectively, and for an hCG level of > 2000 IU/L they were 10.9% (5/46) and 95.2% (458/481), respectively.

CONCLUSIONS

Varying the discriminatory zone does not significantly improve the detection of ectopic pregnancy in a PUL population. A single measurement of serum hCG is not only potentially falsely reassuring but also unhelpful in excluding the presence of an ectopic pregnancy.

摘要

目的

目前，不同的血清人绒毛膜促性腺激素（hCG）鉴别阈值被用于评估经阴道超声检查后被归类为妊娠部位不明（PUL）的女性发生异位妊娠的可能性。我们评估了血清hCG水平>1000 IU/L、1500 IU/L和2000 IU/L的鉴别阈值在检测此类女性异位妊娠方面的诊断准确性。

方法

这是一项对在专门的经阴道扫描科室接受评估的女性进行的前瞻性观察研究。所有PUL女性在就诊时均检测血清hCG。对PUL采用期待管理。对这些女性进行经阴道超声随访、监测血清激素水平并进行腹腔镜检查，直至确立最终诊断：PUL失败、宫内妊娠（IUP）、异位妊娠或持续性PUL。持续性PUL可能代表超声检查遗漏的异位妊娠，这些被纳入异位妊娠组。评估了三个不同的鉴别阈值（1000 IU/L、1500 IU/L和2000 IU/L）用于预测该PUL人群中的异位妊娠。

结果

2001年6月25日至2003年4月14日期间，共有5544名连续的女性到早孕科室就诊。其中，569名（10.3%）女性被归类为PUL，其中42名失访。在分析的527例（9.5%）PUL病例中，有300例（56.9%）PUL失败，181例（34.3%）IUP，46例（8.7%）异位妊娠。总体而言，74.6%有症状，25.4%无症状（P = 8.825E - 07）。hCG水平>1000 IU/L检测异位妊娠的敏感性和特异性分别为21.7%（10/46）和87.3%（420/481）；hCG水平>1500 IU/L时，这些值分别为15.2%（7/46）和93.4%（449/481），hCG水平>2000 IU/L时分别为10.9%（5/46）和95.2%（458/481）。