Sauer M V, Rodi I A
Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance.
Int J Gynaecol Obstet. 1990 Jan;31(1):29-34. doi: 10.1016/0020-7292(90)90178-n.
In recent years, algorithms have been proposed to evaluate ectopic gestations. To determine the usefulness of an algorithm for a large county hospital, a surveillance project was initiated. During 2 years, 4045 women were screened in the emergency room for pregnancy. Of these, 1648 (41%) were noted to be pregnant, initially detected by rapid enzyme immunoassay for urinary human chorionic gonadotropin, and later confirmed using quantitative radioimmunoassay for serum human chorionic gonadotropin. Within this group, 249 women were diagnosed with ectopic pregnancies. Hemoperitoneum was discovered by culdocentesis in 128 of 249 cases of ectopic gestations, all operated upon acutely. A discriminatory zone for ultrasound was diagnostic of ectopic pregnancy in only 33 cases, as the majority of women presented with human chorionic gonadotropin levels below 6500 mIU/ml. Uterine curettage performed when abnormal serial levels of chorionic gonadotropin were observed detected an additional 46 cases. Early diagnosis permitted treatment prior to tubal rupture in 147 instances with conservation of the fallopian tube in 125 (50%). We conclude: (1) even in a busy county emergency room, algorithms are useful for expediting the diagnosis of ectopic pregnancy; (2) when ectopics are diagnosed early, conservative tubal surgery is possible in many patients.
近年来，已有人提出评估异位妊娠的算法。为确定某大型县级医院采用一种算法的实用性，启动了一项监测项目。在两年时间里，有4045名女性在急诊室接受了妊娠筛查。其中，1648名（41%）被发现怀孕，最初通过尿人绒毛膜促性腺激素快速酶免疫测定法检测出来，随后通过血清人绒毛膜促性腺激素定量放射免疫测定法予以确诊。在这一组中，有249名女性被诊断为异位妊娠。在249例异位妊娠病例中，有128例通过后穹窿穿刺发现有腹腔内出血，所有这些病例均接受了急诊手术。超声检查的鉴别区域仅诊断出33例异位妊娠，因为大多数女性的人绒毛膜促性腺激素水平低于6500 mIU/ml。当观察到绒毛膜促性腺激素水平出现异常连续变化时进行的刮宫术又检测出另外46例。早期诊断使得147例患者在输卵管破裂前得到治疗，其中125例（50%）的输卵管得以保留。我们得出结论：（1）即使在繁忙的县级急诊室，算法对于加快异位妊娠的诊断也是有用的；（2）当异位妊娠被早期诊断时，许多患者有可能接受保守性输卵管手术。
