Condous George
Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2009 Aug;49(4):346-51. doi: 10.1111/j.1479-828X.2009.01032.x.
Ectopic pregnancy is still the number one cause of maternal deaths in early pregnancy. The diagnostic capabilities of transvaginal ultrasound to confirm an EP are well founded. In fact, ultrasound technology, particularly the introduction of high-resolution transvaginal probes, has been the driving force behind the revolutionary change towards conservative management strategies in ectopic pregnancy care. Clinically stable women, however, with a scan diagnosis of a tubal ectopic pregnancy still routinely undergo surgery or are given methotrexate (MTX) at presentation. Conservative management for ectopic pregnancy may be considered in the context of clinical stability. Reassessment at 48 h allows evaluation of the trophoblast activity or 'trophoblastic load'. Falling serum hCG levels at 48 h suggest that the ectopic trophoblast is resolving spontaneously and it may be possible to avoid methotrexate administration in this sub-group. Women with increasing serum hCG levels at 48 h, indicating the trophoblast is still active, should be targeted for methotrexate. By calculating the pre-treatment hCG ratio (hCG 48 h/hCG 0 h), it is possible to triage women with an ectopic pregnancy for conservative management. There are, however, no randomised data to support the use of MTX over expectant management. In this review, some of the current management strategies in ectopic pregnancy management will be challenged.
异位妊娠仍然是孕早期孕产妇死亡的首要原因。经阴道超声诊断异位妊娠的能力是有充分依据的。事实上，超声技术，尤其是高分辨率经阴道探头的引入，一直是异位妊娠护理向保守治疗策略转变的革命性变革背后的驱动力。然而，临床上稳定的女性，经扫描诊断为输卵管异位妊娠，在就诊时仍常规接受手术或给予甲氨蝶呤（MTX）。在临床稳定的情况下可考虑对异位妊娠进行保守治疗。48小时后重新评估可评估滋养层活性或“滋养层负荷”。48小时时血清hCG水平下降表明异位滋养层正在自发消退，在该亚组中可能避免使用甲氨蝶呤。48小时时血清hCG水平升高的女性，表明滋养层仍活跃，应给予甲氨蝶呤治疗。通过计算治疗前hCG比值（hCG 48小时/hCG 0小时），可以对异位妊娠女性进行保守治疗的分类。然而，没有随机数据支持使用MTX而非期待治疗。在本综述中，异位妊娠管理中的一些当前治疗策略将受到挑战。
