Vidaković Snezana, Dokić Milan, Vilendecić Zoran, Maravić Maja Djakonović
Clinic for Gynaecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia.
Srp Arh Celok Lek. 2013 Sep-Oct;141(9-10):689-92. doi: 10.2298/sarh1310689v.
Transvaginal sonography and human chorionic gonadotropin (hCG) testing are cornerstones of modern clinical practice in cases with the suspected ectopic pregnancy. In unclear cases, if the level of hCG is above the discriminatory zones, the use of uterine curettage is recommended.There is an increasing concern that strict observation of the guidelines would potentially harm otherwise normal early intrauterine pregnancies in certain cases.
A 35-year-old woman was admitted to hospital due to a severe lower abdominal pain. Based on the positive pregnancy test and sonographic exams which failed to demonstrate intrauterine pregnancy, the diagnosis of ectopic pregnancy was presumed. Laparoscopy revealed ruptured corpus luteum cyst and the diagnosis was confirmed on histopathological finding. Postoperatively, normal intrauterine gestation was visualised.
Since the diagnosis of early pregnancy and its complications can be misleading, in unclear cases, we support the expectative "wait and see" management consisting of serial hCG testing and repeated ultrasound examinations. Avoidance of uterine curettage in such unclear cases would further reduce the possibility of normal early pregnancy interruption.
经阴道超声检查和人绒毛膜促性腺激素(hCG)检测是疑似异位妊娠现代临床实践的基石。在不明确的病例中,如果hCG水平高于鉴别区间,建议进行刮宫术。人们越来越担心,在某些情况下严格遵循指南可能会对原本正常的早期宫内妊娠造成潜在伤害。
一名35岁女性因严重下腹痛入院。基于妊娠试验阳性及超声检查未发现宫内妊娠,推测诊断为异位妊娠。腹腔镜检查发现黄体囊肿破裂,组织病理学检查确诊。术后,可见正常宫内妊娠。
由于早期妊娠及其并发症的诊断可能具有误导性,在不明确的病例中,我们支持采取期待性的“观察等待”管理,包括连续hCG检测和重复超声检查。在此类不明确病例中避免刮宫术将进一步降低正常早期妊娠中断的可能性。