Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Am J Obstet Gynecol. 2011 Feb;204(2):130.e1-6. doi: 10.1016/j.ajog.2010.11.021.
We sought to determine utility of uterine evacuation for diagnosis of nonviable pregnancy of unknown location (PUL).
We conducted a cohort study to assess the prevalence of ectopic pregnancy (EP), overall, and stratified by presenting signs and symptoms in women with a nonviable PUL.
Of the 173 women, 66 (38%) had miscarriage (spontaneous abortion [SAB]) and 107 (62%) had EP. When initial human chorionic gonadotropin (hCG) was <2000 mIU/mL, the odds of an EP were greater (odds ratio, 4.32; 95% confidence interval, 2.04-9.12). Demographic factors, obstetric history, and clinical presentation were not useful in distinguishing between EP and SAB. Pre-evacuation hCG increase had strong trend association with EP (odds ratio, 2.14; 95% confidence interval, 0.98-4.68). A >30% fall in postcurettage hCG was suggestive, but was not a diagnostic indicator of SAB.
Uterine evacuation is a useful diagnostic aid for women with nonviable PUL. Nondiagnostic ultrasound findings and absolute and serial hCG values are associated with, but do not accurately predict final diagnosis.
我们旨在确定子宫排空术对诊断不明位置（PUL）的不可存活妊娠的作用。
我们进行了一项队列研究，以评估在具有不可存活 PUL 的女性中，异位妊娠（EP）的总体发生率以及按表现症状分层的发生率。
在 173 名女性中，66 名（38%）发生了流产（自然流产[SAB]），107 名（62%）发生了 EP。当初始人绒毛膜促性腺激素（hCG）<2000 mIU/mL 时，EP 的可能性更大（比值比，4.32；95%置信区间，2.04-9.12）。人口统计学因素、产科史和临床表现均不能区分 EP 和 SAB。预排空 hCG 增加与 EP 呈强烈趋势关联（比值比，2.14；95%置信区间，0.98-4.68）。刮宫后 hCG 下降>30%提示，但不是 SAB 的诊断指标。
子宫排空术对不可存活 PUL 的女性是一种有用的诊断辅助手段。非诊断性超声发现以及绝对和连续 hCG 值与但不能准确预测最终诊断有关。
