Panelli Danielle M, Phillips Catherine H, Brady Paula C
Department of Obstcpetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA.
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA.
Fertil Res Pract. 2015 Oct 15;1:15. doi: 10.1186/s40738-015-0008-z. eCollection 2015.
Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar.
Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality.
This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
异位妊娠是一种潜在的危及生命的疾病，在所有妊娠中发生率为1%-2%。最常见的异位着床部位是输卵管，不过10%的异位妊娠着床于宫颈、卵巢、子宫肌层、输卵管间质部、腹腔或剖宫产瘢痕内。
诊断需要结合临床症状、血清学检查和超声检查。对于大多数临床状况稳定的患者，药物治疗是一种安全有效的选择。药物治疗失败、不符合条件、出现异位妊娠破裂或同时发生宫内宫外复合妊娠的患者，大多通过腹腔镜手术切除治疗，较少采用剖腹手术。非输卵管异位妊娠的治疗可能涉及药物治疗、手术治疗或两者结合，具体取决于异位妊娠的位置和患者的临床稳定性。输卵管异位妊娠后，后续宫内妊娠的几率较高，且与治疗方式无关。
本综述描述了输卵管性和非输卵管性异位妊娠及宫内宫外复合妊娠的发生率、危险因素、诊断和治疗，并回顾了有关复发和未来生育能力的现有数据。
