Raccuia J S, Neckles S, Butler D, Kahn M, Ibrahim I M
Department of Surgery, Englewood Hospital, New Jersey 07062.
Surg Gynecol Obstet. 1989 May;168(5):417-20.
Although synchronous intrauterine and ectopic pregnancies associated with the use of clomiphene citrate for infertility are rare, the actual incidence might, in fact, be considerably higher than previously thought. The cornerstone for ruling out an extrauterine gestation is the presence of sonographic evidence of an intrauterine pregnancy, as the possibility of concomitant intrauterine and extrauterine gestation is perceived to be statistically rare. This has resulted in an unacceptably high incidence of negative ultrasound interpretations. During a recent 12 month period, four women treated with clomiphene citrate for infertility were diagnosed as having concomitant intrauterine and ectopic pregnancies. Three had pelvic sonograms that were erroneous for the extrauterine component. However, successful evacuation of the products of ectopic gestation was performed in each, despite an immediate preoperative false-negative ultrasound report. Three of the women delivered healthy normal infants at full term, and the fourth woman spontaneously aborted the products of the concomitant intrauterine gestation. All four did well postoperatively, and no gross complications were encountered. Reassessment of ultrasound diagnostic criteria and the use of more sensitive methods, such as endovaginal ultrasound in high risk patients, are indicated for any symptomatic patient using clomiphene citrate for infertility. Awareness of the prevalence of this entity and the limitations of ultrasound will lead to prompt intervention and improved survival rates.
尽管使用枸橼酸氯米芬治疗不孕症时发生的同步宫内和异位妊娠很罕见，但实际发生率可能实际上比以前认为的要高得多。排除宫外妊娠的关键是存在宫内妊娠的超声证据，因为同时存在宫内和宫外妊娠的可能性在统计学上被认为很罕见。这导致了超声检查阴性结果的发生率高得令人无法接受。在最近的12个月期间，四名接受枸橼酸氯米芬治疗不孕症的妇女被诊断为同时患有宫内和异位妊娠。其中三名患者的盆腔超声检查对宫外部分的诊断有误。然而，尽管术前超声报告立即为假阴性，但每例患者均成功清除了异位妊娠产物。三名妇女足月分娩出健康正常的婴儿，第四名妇女自然流产了同时存在的宫内妊娠产物。所有四名患者术后情况良好，未出现严重并发症。对于任何使用枸橼酸氯米芬治疗不孕症的有症状患者，都应重新评估超声诊断标准并使用更敏感的方法，如对高危患者进行经阴道超声检查。了解这种情况的普遍性和超声检查的局限性将有助于及时干预并提高生存率。
