Debnath Jyotindu, Gulati Surendra Kumar, Mathur Ankit, Gupta Ritu, Kumar Nikhilesh, Arora Sunil, Krishna R Bala Murali
Department of Radiodiagnosis & Imaging, 167 Military Hospital, Pathankot, 145001 Punjab India.
Department of Obstetrics Gynecology, Subharti Medical College, Meerut, India.
J Obstet Gynaecol India. 2013 Dec;63(6):388-93. doi: 10.1007/s13224-013-0459-2. Epub 2013 Aug 14.
The aim of this study was to share our experience of clinical presentation and ultrasonographic findings in cases of ectopic pregnancy especially in the context of usage of unsupervised medical abortifacients.
This is prospective study conducted over a period of 1 year extending from August 01, 2009 to July 31, 2010 in a tertiary care Armed Forces Hospital of India.
Clinically and or sonologically suspected cases of ectopic pregnancy formed the study group. Detailed clinical, menstrual, and treatment history was obtained for each patient. Ultrasonography (USG) was done with multifrequency convex (2.5-6 MHz) followed by transvaginal (6-10 MHz) probes. Operative findings were noted and recorded in each case.
In the study period, a total of 1958 pregnant patients were admitted and treated, which included 1690 deliveries and 268 abortions. Based on USG findings, 16 cases (0.8 %) of ectopic pregnancy were diagnosed. While four patients were treated medically (with methotrexate), 12 cases underwent surgery. Out of 16 cases, 10 cases were suspected clinically as ectopic pregnancy. Features suggestive of menorrhagia, threatened abortion, and pelvic inflammatory disease were present in five, three, and three cases, respectively. History of intake of medical abortifacients (MA) (mifepristone followed by misoprostol) was present in 07 (43.75 %) cases. On USG, commonest abnormality was a complex adnexal mass seen in 12 (75 %) cases. Gestational sac with definite embryo within and surrounding echogenic rim was seen in five cases. Live ectopic pregnancy was diagnosed in two (12.5 %) cases. Endometrial thickness was less than 10 mm in all cases who had taken MA. Pseudo gestation sac was seen in 02 (12.5 %) cases. Significant hemoperitoneum was present in 10 out of 12 cases operated. Organized hematoma in pelvis masking the presence of adnexal mass was noted in three cases.
Over-the-counter availability, failure to strictly follow the guidelines, unsupervised usage of MA along with atypical clinical history have increased diagnostic dilemma in ectopic pregnancy. Sonographic findings are frequently atypical in such cases. Ectopic pregnancy may remain under-diagnosed with potentially serious consequences in patients who have taken MA without prior confirmation of intrauterine gestation.
本研究的目的是分享我们在异位妊娠病例中的临床表现和超声检查结果，特别是在使用无监管堕胎药的背景下。
这是一项前瞻性研究，于2009年8月1日至2010年7月31日在印度一家三级护理武装部队医院进行，为期1年。
临床和/或超声怀疑为异位妊娠的病例组成研究组。为每位患者获取详细的临床、月经和治疗史。使用多频率凸阵探头（2.5 - 6MHz）然后经阴道探头（6 - 10MHz）进行超声检查（USG）。记录每个病例的手术结果。
在研究期间，共收治1958例妊娠患者，其中包括1690例分娩和268例流产。根据超声检查结果，诊断出16例（0.8%）异位妊娠。4例患者接受药物治疗（使用甲氨蝶呤），12例接受手术。16例中，10例临床怀疑为异位妊娠。分别有5例、3例和3例存在月经过多、先兆流产和盆腔炎的特征。7例（43.75%）有服用堕胎药（米非司酮后加用米索前列醇）的病史。超声检查时，最常见的异常是12例（75%）出现附件区混合性包块。5例可见妊娠囊内有明确胚胎且周围有回声环。2例（12.5%）诊断为存活的异位妊娠。所有服用堕胎药的病例子宫内膜厚度均小于10mm。2例（12.5%）可见假妊娠囊。12例手术病例中有10例存在明显腹腔内出血。3例盆腔内有机化血肿掩盖了附件区包块的存在。
非处方可得、未严格遵循指南、无监管使用堕胎药以及不典型的临床病史增加了异位妊娠的诊断难题。在此类病例中，超声检查结果常常不典型。对于在未事先确认宫内妊娠的情况下服用堕胎药的患者，异位妊娠可能仍诊断不足，从而带来潜在的严重后果。
