Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
J Minim Invasive Gynecol. 2013 Jul-Aug;20(4):446-54. doi: 10.1016/j.jmig.2013.02.004. Epub 2013 Apr 12.
The incidence of ectopic pregnancy is approximately 2% of all pregnancies, and it remains the leading cause of death in early pregnancy. Over 95% of ectopic pregnancies are tubal pregnancies, and the remainders are nontubal pregnancies. The highest risk factor for ectopic pregnancy is a previous tubal pregnancy followed by previous tubal surgery, tubal sterilization, tubal pathology, and current intrauterine device use. The apparent increase in the incidence of nontubal ectopic pregnancy including heterotopic pregnancy may be attributed to the increasing number of pregnancies because of in vitro fertilization treatment. In most cases, an ectopic pregnancy can be treated medically with a single dose of methotrexate. Surgical treatment is still needed in women who are hemodynamically unstable and in those who do not fulfill the criteria for methotrexate treatment. Usually surgical treatment can be performed by laparoscopy and in some cases by hysteroscopy. Laparotomy is rarely needed even in women with intraperitoneal bleeding.
宫外孕的发病率约为所有妊娠的 2%，仍是妊娠早期死亡的主要原因。超过 95%的宫外孕为输卵管妊娠，其余为非输卵管妊娠。宫外孕的最高危险因素是既往输卵管妊娠，其次是既往输卵管手术、输卵管绝育术、输卵管病变和当前宫内节育器使用。包括异位妊娠在内的非输卵管宫外孕的发病率明显增加，可能归因于体外受精治疗导致妊娠次数增加。在大多数情况下，宫外孕可以用单次甲氨蝶呤治疗。对于血流动力学不稳定的妇女和不符合甲氨蝶呤治疗标准的妇女，仍需要手术治疗。通常可以通过腹腔镜进行手术治疗，在某些情况下也可以通过宫腔镜进行手术治疗。即使有腹腔内出血，剖腹手术也很少需要。
