Elito Junior Julio, Camano Luiz
Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Sao Paulo Med J. 2006 Nov 7;124(6):321-4. doi: 10.1590/s1516-31802006000600004.
There is evidence that ectopic pregnancies present different behavioral patterns. These distinct evolutions of ectopic pregnancies represent two different natural histories. To evaluate these evolution patterns, we compared patients undergoing medical treatment and expectant management according to their gestational age and initial beta-hCG levels.
Prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center.
Among 119 cases of unruptured ectopic pregnancies diagnosed from April 1999 to February 2004, 57 received systemic treatment with methotrexate 50 mg/m(2) (body surface area) intramuscularly and 62 were managed expectantly. In this study we evaluated the beta-hCG levels at presentation and amenorrhea duration.
There was a significant difference between the two groups regarding amenorrhea duration and initial beta-hCG levels (p < 0.001). The group with decreasing beta-hCG levels (managed expectantly) had longer amenorrhea (mean: 8.87 +/- 1.71 weeks) and lower initial beta-hCG levels (mean: 648.8 +/- 754.7 mIU/ml). On the other hand, the group treated with methotrexate had shorter amenorrhea (mean: 6.81 +/- 1.88 weeks) and higher beta-hCG levels at presentation (2642.7 +/- 2315.1 mIU/ml).
The data suggest that ectopic pregnancies can be categorized into two groups: those with early diagnosis and shorter amenorrhea, increasing or maintained beta-hCG levels over 24 and 48-hour intervals and higher beta-hCG levels requiring medical treatment; and those with late diagnosis and longer amenorrhea, decreased beta-hCG levels over 24 and 48-hour intervals and lower beta-hCG levels requiring expectant management.
有证据表明异位妊娠呈现出不同的行为模式。这些异位妊娠的不同演变代表了两种不同的自然病程。为评估这些演变模式，我们根据孕周和初始β - 人绒毛膜促性腺激素（β - hCG）水平，对接受药物治疗和期待治疗的患者进行了比较。
在圣保罗联邦大学产科进行的前瞻性研究，该科室为三级医疗中心。
在1999年4月至2004年2月诊断出的119例未破裂异位妊娠病例中，57例接受了50 mg/m²（体表面积）甲氨蝶呤肌肉注射的全身治疗，62例接受期待治疗。在本研究中，我们评估了就诊时的β - hCG水平和闭经持续时间。
两组在闭经持续时间和初始β - hCG水平方面存在显著差异（p < 0.001）。β - hCG水平下降的组（接受期待治疗）闭经时间更长（平均：8.87 ± 1.71周），初始β - hCG水平更低（平均：648.8 ± 754.7 mIU/ml）。另一方面，接受甲氨蝶呤治疗的组闭经时间更短（平均：6.81 ± 1.88周），就诊时β - hCG水平更高（2642.7 ± 2315.1 mIU/ml）。
数据表明异位妊娠可分为两组：一组为诊断较早、闭经时间较短、β - hCG水平在24小时和48小时间隔内升高或维持且β - hCG水平较高需要药物治疗；另一组为诊断较晚、闭经时间较长、β - hCG水平在24小时和48小时间隔内下降且β - hCG水平较低需要期待治疗。
