Garcia A J, Aubert J M, Sama J, Josimovich J B
Fertil Steril. 1987 Sep;48(3):395-400. doi: 10.1016/s0015-0282(16)59405-9.
Thirteen patients with presumed diagnosis of unruptured ectopic pregnancy underwent expectant management. The diagnosis was based on the criteria of clinical stability, no intrauterine gestation sac by sonogram, and falling beta subunit human chorionic gonadotropin titer. The diagnosis also was based on no gross evidence of trophoblastic tissue on sharp curettage and alteration in uterotubal anatomy at laparoscopy. In these 13 patients, titers continued to drop and were below assay detectability (1.5 miu/ml) by 1 to 5 weeks. Only one patient required a laparotomy. Hysterosalpingograms in ten of the patients showed normal, patent tubes in seven. One patient had cornual occlusion and two showed a hydrosalpinx with spillage. A second laparoscopy in seven patients demonstrated normal tubes in all but one. At present, three patients have delivered term infants and two have had first trimester spontaneous abortions. These observations suggest that expectant management of tubal pregnancies is appropriate under rigidly controlled conditions.
13例初步诊断为未破裂异位妊娠的患者接受了期待治疗。诊断依据为临床稳定、超声检查未发现宫内妊娠囊以及β亚单位人绒毛膜促性腺激素滴度下降。诊断还基于刮宫时未发现滋养层组织的明显证据以及腹腔镜检查时子宫输卵管解剖结构的改变。在这13例患者中，滴度持续下降，1至5周后低于检测下限（1.5 mIU/ml）。仅1例患者需要剖腹手术。10例患者的子宫输卵管造影显示，7例输卵管正常且通畅。1例患者有宫角阻塞，2例显示输卵管积水伴造影剂外溢。7例患者再次接受腹腔镜检查，除1例外其余患者输卵管均正常。目前，3例患者已足月分娩，2例患者发生了孕早期自然流产。这些观察结果表明，在严格控制的条件下，对输卵管妊娠进行期待治疗是合适的。
