Condous George
Early Pregnancy Unit, Nepean Centre for Perinatal Care and Research, Nepean Clinical School, University of Sydney, New South Wales.
Aust Fam Physician. 2006 Nov;35(11):854-7.
Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities.
Detailed management will not be discussed in this review. However, risk factors for tubal ectopic pregnancy, ultrasound diagnosis and the benefits of early pregnancy units will be discussed.
All women in the reproductive age group who present to a general practitioner or hospital emergency department with lower abdominal pain, with or without vaginal bleeding, have an ectopic pregnancy until proven otherwise. A urinary pregnancy test is mandatory in this clinical situation and if positive, these women should then have a transvaginal--not transabdominal--ultrasound scan (TVS) performed. The diagnosis of ectopic pregnancy should be based on the positive visualisation of an adnexal mass using TVS rather than on the basis of a scan that fails to demonstrate an intrauterine gestational sac. Diagnosing the condition earlier in its natural history using TVS has changed management options and reduced the associated mortality, with collapse and subsequent emergency laparotomy being the exception rather than the rule in modern practice. Early pregnancy units have been shown to benefit women with early pregnancy complications, reduce unnecessary admissions, reduce costs and are an effective use of resources.
异位妊娠仍是孕早期孕产妇死亡的最常见原因，占早期妊娠死亡的73%。
本综述不讨论具体的管理方法。然而，将讨论输卵管异位妊娠的危险因素、超声诊断以及早期妊娠单元的益处。
所有育龄期女性，若因下腹痛就诊于全科医生或医院急诊科，无论有无阴道出血，在确诊排除其他情况之前均应考虑异位妊娠。在此临床情况下，尿妊娠试验是必需的；若结果为阳性，这些女性应接受经阴道而非经腹超声扫描（TVS）。异位妊娠的诊断应基于TVS对附件包块的阳性显示，而非基于未能显示宫内妊娠囊的扫描结果。使用TVS在疾病自然史的早期进行诊断，改变了管理选择并降低了相关死亡率，在现代实践中，出现休克及随后进行急诊剖腹手术已非常罕见，而不再是常规情况。早期妊娠单元已被证明对患有早期妊娠并发症的女性有益，可减少不必要的住院，降低成本，并有效利用资源。
