Phillips Catherine H, Wortman Jeremy R, Ginsburg Elizabeth S, Sodickson Aaron D, Doubilet Peter M, Khurana Bharti
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Infertility and Reproductive Surgery, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Emerg Radiol. 2018 Feb;25(1):61-72. doi: 10.1007/s10140-017-1556-9. Epub 2017 Sep 25.
The purpose of this article is to help the practitioner ensure early diagnosis and response to emergencies in the first trimester by reviewing anatomy of the developing embryo, highlighting the sonographic appearance of common first-trimester emergencies, and discussing key management pathways for treating emergent cases. First-trimester fetal development is a stepwise process that can be challenging to evaluate in the emergency department (ED) setting. This is due, in part, to the complex anatomy of early pregnancy, subtlety of the sonographic findings, and the fact that fewer than half of patients with ectopic pregnancy present with the classic clinical findings of a positive pregnancy test, vaginal bleeding, pelvic pain, and tender adnexa. Ultrasound (US) has been the primary approach to diagnostic imaging of first-trimester emergencies, with magnetic resonance imaging (MRI) and computed tomography (CT) playing a supportive role in a small minority of cases. Familiarity with the sonographic findings diagnostic of and suspicious for early pregnancy failure, ectopic pregnancy, retained products of conception, gestational trophoblastic disease, failed intrauterine devices, and complications associated with assisted reproductive technology (ART) is critical for any emergency radiologist. Evaluation of first-trimester emergencies is challenging, and knowledge of key imaging findings and familiarity with management pathways are needed to ensure early diagnosis and response.
本文旨在通过回顾发育中胚胎的解剖结构、突出早孕期常见急症的超声表现以及讨论处理急症病例的关键管理途径，帮助从业者确保在孕早期实现早期诊断并应对急症。孕早期胎儿发育是一个循序渐进的过程，在急诊科环境中进行评估可能具有挑战性。部分原因在于早孕的解剖结构复杂、超声检查结果细微，以及异位妊娠患者中不到一半呈现出妊娠试验阳性、阴道出血、盆腔疼痛和附件压痛等典型临床症状。超声（US）一直是孕早期急症诊断成像的主要方法，磁共振成像（MRI）和计算机断层扫描（CT）在少数情况下起辅助作用。对于任何急诊放射科医生而言，熟悉诊断及疑似早孕失败、异位妊娠、妊娠物残留、妊娠滋养细胞疾病、宫内节育器失败以及与辅助生殖技术（ART）相关并发症的超声表现至关重要。孕早期急症的评估具有挑战性，需要掌握关键成像表现并熟悉管理途径，以确保早期诊断和应对。
