Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, Australia.
Ultrasound Obstet Gynecol. 2009 Jun;33(6):711-5. doi: 10.1002/uog.6384.
Hemoperitoneum is accepted as an indication for surgery in women with tubal ectopic pregnancy. The aim of this pilot study was to evaluate the feasibility of managing such women non-surgically.
This was a prospective observational study. Women with tubal ectopic pregnancy and hemoperitoneum detected on transvaginal sonography (TVS) were managed as inpatients either expectantly or with methotrexate (MTX). Inclusion criteria for conservative management were: compliance, clinical stability, absence of acute abdomen, stable hemoglobin level on two measurements (0 and 12-24 h apart), serum human chorionic gonadotropin (hCG) < 5000 IU/L, absence of fetal cardiac activity on TVS and absence of significant hemoperitoneum, defined as blood above the level of the uterine fundus and/or in Morison's pouch (hepatorenal space). Subsequent management was based upon the hCG ratio at 48 h. All the women were managed as inpatients until the abdominal pain settled and the serum hCG levels were falling.
Forty-one women with tubal ectopic pregnancy presented between November 2006 and March 2008. Eight women (20%) fulfilled the entry criteria. The median gestational age at diagnosis was 49 (interquartile range, 38-52.5) days. All women presented with lower abdominal pain/right iliac fossa or left iliac fossa pain. Hemoglobin levels ranged from 11.2 to 14.2 g/dL at presentation and from 12.0 to 14.8 g/dL after 12-24 h. 6/8 (75%) women were managed expectantly and 2/8 (25%) received MTX. All women had resolution of their ectopic pregnancy within 3 weeks with no complications.
This pilot study suggests that the finding of hemoperitoneum on ultrasound examination may not be an absolute contraindication to conservative management of tubal ectopic pregnancy.
腹腔积血被认为是输卵管妊娠妇女手术的指征。本研究的目的是评估非手术治疗此类患者的可行性。
这是一项前瞻性观察研究。经阴道超声（TVS）发现输卵管妊娠合并腹腔积血的患者，住院后或接受甲氨蝶呤（MTX）治疗。保守治疗的纳入标准为：依从性好、临床稳定、无急腹症、两次测量（0 小时和 12-24 小时）血红蛋白水平稳定、血清人绒毛膜促性腺激素（hCG）<5000IU/L、TVS 未见胎儿心管搏动且腹腔积血不明显，定义为子宫底以上和/或肝肾隐窝（Morison 窝）的积血。随后根据 48 小时 hCG 比值进行治疗。所有患者均在腹痛缓解且血清 hCG 水平下降后出院。
2006 年 11 月至 2008 年 3 月期间共有 41 例输卵管妊娠患者就诊。符合入组标准的患者有 8 例（20%）。诊断时的中位孕龄为 49（四分位间距，38-52.5）天。所有患者均表现为下腹痛/右髂窝或左髂窝疼痛。就诊时血红蛋白水平为 11.2-14.2g/dL，12-24 小时后为 12.0-14.8g/dL。6/8（75%）例患者接受期待治疗，2/8（25%）例患者接受 MTX 治疗。所有患者在 3 周内异位妊娠均得到解决，无并发症发生。
本研究提示超声检查发现腹腔积血可能不是输卵管妊娠保守治疗的绝对禁忌证。
