Ko Jennifer K Y, Cheung Vincent Y T
MBMRCOG, Queen Mary Hospital, 102 Pokfulam Rd, 6/F, Professorial Block, Hong Kong.
J Ultrasound Med. 2014 Mar;33(3):465-71. doi: 10.7863/ultra.33.3.465.
The purpose of this study was to review the management and outcomes of all patients with pregnancy of unknown location who had serum human chorionic gonadotropin (hCG) levels greater than 1000 mIU/mL in our institution and to determine the likelihood of a subsequent normal intrauterine pregnancy at different hCG discriminatory levels.
A retrospective review was performed on all women admitted with the diagnosis of pregnancy of unknown location and an hCG level greater than 1000 mIU/mL over a 5-year period (July 2007 to June 2012). Patients were identified from a computerized hCG result database. The medical records, including sonographic findings, hCG levels, and outcomes, were reviewed.
A total of 113 patients were identified. There were 23 viable intrauterine pregnancies (20.4%) and 22 visualized ectopic pregnancies (19.5%). The highest hCG level associated with a subsequent normal intrauterine pregnancy was 9083 mIU/mL in a patient with triplet pregnancy. Possible factors associated with nonvisualization of a normal intrauterine pregnancy included uterine fibroids, adenomyosis, endometrial polyps, and obesity. The negative laparoscopy rate was 48.8%.
Viable intrauterine pregnancy is possible in patients with pregnancy of unknown location and hCG levels above the generally accepted discriminatory zone, strict adherence to which can potentially disrupt a normal pregnancy. We support the need for judicious use of the hCG discriminatory level in hemodynamically stable patients with pregnancy of unknown location, and the decision to intervene should not be based solely on a single hCG level.
本研究旨在回顾我院所有血清人绒毛膜促性腺激素（hCG）水平大于1000 mIU/mL的不明部位妊娠患者的管理情况及结局，并确定在不同hCG鉴别水平下后续正常宫内妊娠的可能性。
对5年期间（2007年7月至2012年6月）所有因不明部位妊娠诊断入院且hCG水平大于1000 mIU/mL的女性进行回顾性研究。通过计算机化的hCG结果数据库识别患者。回顾病历，包括超声检查结果、hCG水平和结局。
共识别出113例患者。有23例活产宫内妊娠（20.4%）和22例可见的异位妊娠（19.5%）。三胎妊娠患者中与后续正常宫内妊娠相关的最高hCG水平为9083 mIU/mL。与正常宫内妊娠未被发现相关的可能因素包括子宫肌瘤、子宫腺肌病、子宫内膜息肉和肥胖。腹腔镜检查阴性率为48.8%。
不明部位妊娠且hCG水平高于普遍接受的鉴别区间的患者有可能发生活产宫内妊娠，严格遵循该区间可能会潜在地干扰正常妊娠。我们支持在血流动力学稳定的不明部位妊娠患者中明智地使用hCG鉴别水平，干预决策不应仅基于单一的hCG水平。
