*Schwartz/Reisman Emergency Medicine Institute,Toronto, ON.
‡Department of Obstetrics and Gynaecology,University of Toronto,Toronto, ON.
CJEM. 2019 Jan;21(1):71-74. doi: 10.1017/cem.2018.13. Epub 2018 Mar 4.
The objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the emergency department (ED) where ectopic pregnancy had not yet been excluded.
This was a retrospective chart review of pregnant (<12-week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule-out ectopic pregnancy, or pregnancy of unknown location over a 7-year period.
Of the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes, and 71 (12.9%) had other outcomes that included therapeutic abortion, molar pregnancy, or resolution of βHCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal ultrasound during their index ED visit, and 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy.
These results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.
本研究旨在确定从排除异位妊娠的急诊科出院的女性中，有多少人发生了破裂性异位妊娠。
这是一项回顾性病历审查，纳入了在学术性三级保健急诊科就诊的、有异位妊娠、排除异位妊娠或妊娠位置不明的、妊娠 <12 周的孕妇，随访时间为 7 年。
550 例纳入患者中，83 例（15.1%）有活胎妊娠，94 例（17.1%）有自发性或难免流产，230 例（41.8%）有异位妊娠，72 例（13.1%）有未知结局，71 例（12.9%）有其他结局，包括药物流产、葡萄胎或β-HCG 水平降低，且未记录到妊娠位置。230 例异位妊娠中，42 例（7.6%）行期待治疗，131 例（23.8%）接受甲氨蝶呤药物治疗，29 例（5.3%）接受手术治疗，28 例（5.1%）患者在急诊科就诊后发生破裂性异位妊娠。550 例纳入患者中，221 例（40.2%）在急诊科就诊时未行经阴道超声检查，73 例（33.0%）随后诊断为异位妊娠。
这些结果可能有助于急诊科医生向有症状的早期妊娠女性提供咨询，告知其从急诊科出院后发生异位妊娠的风险。
