Majhi Arup Kumar, Roy Nilotpal, Karmakar Kakali Sinha, Banerjee Pradip Kumar
Departmeht of Obstetrics and Gynaecology, NRS Medical College, Kolkata.
J Indian Med Assoc. 2007 Jun;105(6):308, 310, 312 passim.
Ectopic pregnancy is the most life threatening emergency in pregnancy. Increase in incidence and impairment in fertility are now the real concerns. The aim of this study was to estimate the epidemiological, diagnostic and therapeutic aspects of ectopic pregnancy with a view to suggest action to improve the prognosis. This was a prospective study carried out at NRS Medical College, Kolkata, among consecutive 180 patients of ectopic pregnancy admitted from January, 2002 to December, 2004. During this period the incidence of ectopic pregnancy was 1 in 161(0.6%). The peak age of incidence was 26-30 years; primi were the most sufferers. There were 65.0% patients was had identifiable risk factors. Tubectomy (14.4%), history of abortion (26.1%), infertility (12.2%), pelvic inflammatory diseases (12.8%) and history of previous surgery (11.1%) were the important risk factors. Amenorrhoea (76.1%), abdominal pain (86.1%) and vaginal bleeding (42.2%) were the frequent presenting complaints. There were 87.8% patients was had pallor, 9.4% were admitted with features of shock. Cervical motion tenderness (82.2%) was the most frequent sign. Urinary beta-hCG was positive in 96.1% cases. Ultrasonography revealed diagnosis in 2/3rds cases among 129 patients. Culdocentesis evoked the diagnosis in 73.3% cases out of 135 patients. In 95.0% cases it was of tubal variety, 70.2% ruptured, 19.9% tubal abortion and 9.9% unruptured. Surgery by open method in the form of salpingectomy (81.9%), salpingo-oophorectomy (9.3%) and salpingostomy (5.3%) were the mainstay of management. Expectant management and medical therapy can be offered only in 1.2% and 1.75% respectively. There was no case fatality. By reducing and identifying the risk factors and 'catching' the patients at the earliest it is possible to improve the prognosis so far as morbidity, mortality and fertility are concerned.
异位妊娠是妊娠期最危及生命的急症。发病率上升和生育能力受损是目前真正令人担忧的问题。本研究的目的是评估异位妊娠的流行病学、诊断和治疗情况，以期提出改善预后的措施。这是一项在加尔各答NRS医学院进行的前瞻性研究，研究对象为2002年1月至2004年12月期间连续收治的180例异位妊娠患者。在此期间，异位妊娠的发病率为1/161（0.6%）。发病的高峰年龄为26 - 30岁；初产妇是最主要的患病群体。65.0%的患者有可识别的危险因素。输卵管切除术（14.4%）、流产史（26.1%）、不孕（12.2%）、盆腔炎（12.8%）和既往手术史（11.1%）是重要的危险因素。闭经（76.1%）、腹痛（86.1%）和阴道出血（42.2%）是常见的就诊主诉。87.8%的患者面色苍白，9.4%的患者因休克症状入院。宫颈举痛（82.2%）是最常见的体征。96.1%的病例尿β - hCG呈阳性。129例患者中，超声检查确诊了2/3的病例。135例患者中，后穹窿穿刺确诊了73.3%的病例。95.0%的病例为输卵管妊娠，70.2%破裂，19.9%输卵管流产，9.9%未破裂。以输卵管切除术（81.9%）、输卵管卵巢切除术（9.3%）和输卵管造口术（5.3%）形式的开放手术是主要的治疗方法。期待治疗和药物治疗分别仅适用于1.2%和1.
