Kathpalia S K, Arora D, Sandhu Namrita, Sinha Pooja
Professor and Head (Obst & Gynae), Andaman Nicobar Islands Institute of Medical Sciences, Port Blair 744104, India.
Senior Advisor (Obst and Gynae), Base Hospital, Delhi Cantt, India.
Med J Armed Forces India. 2018 Apr;74(2):172-176. doi: 10.1016/j.mjafi.2016.11.004. Epub 2017 Jan 3.
Ectopic pregnancy or extrauterine pregnancy will invariably result in abortion or rupture. Though there are risk factors for ectopic pregnancy, but at times the condition can occur without any apparent predisposing factor. Cases admitted with provisional diagnosis of ectopic pregnancy were included in this prospective study.
Eighty suspected cases of ectopic pregnancy were incorporated in the study. The management was done based on standard practice. All the cases underwent urine pregnancy test, routine blood investigations including blood group, and transvaginal ultrasound. Serial βhCG was measured in cases where the diagnosis was not clear initially.
Incidence of ectopic was 2.46 per 100 deliveries; there was no apparent risk factor in 28.7% and many cases had more than one risk factor. 'Triad' of ectopic was present in only 21 cases. Sixteen cases were asymptomatic and two were admitted as emergency. Ultrasound findings were inconsistent and wide ranging. In 37 doubtful cases, βhCG was measured serially.There was one case of suspected interstitial pregnancy confirmed on laparoscopy. Twenty-seven cases were managed medically, and 9 were managed expectantly. Forty-six cases were managed surgically either by laparoscopy or by laparotomy. Salpingectomy was performed in 37 cases, and salpingostomy in 7 cases either laparoscopically or by laparotomy.
Ectopic pregnancy can be managed by laparotomy, operative laparoscopy, and medically and occasionally by observation alone. Management must be customized to the clinical condition and needs of future fertility of the patient.
异位妊娠或宫外孕最终都会导致流产或破裂。尽管存在异位妊娠的危险因素，但有时该病可在无任何明显诱发因素的情况下发生。本前瞻性研究纳入了初步诊断为异位妊娠的入院病例。
80例疑似异位妊娠病例纳入本研究。治疗按照标准操作进行。所有病例均进行尿妊娠试验、包括血型在内的常规血液检查以及经阴道超声检查。对于最初诊断不明确的病例，测定其连续β人绒毛膜促性腺激素（βhCG）水平。
异位妊娠发生率为每100例分娩中有2.46例；28.7%的病例无明显危险因素，许多病例有不止一个危险因素。仅21例出现异位妊娠“三联征”。16例无症状，2例作为急诊入院。超声检查结果不一致且范围广泛。在37例可疑病例中，连续测定βhCG水平。1例疑似间质部妊娠经腹腔镜检查确诊。27例接受药物治疗，9例接受期待治疗。46例通过腹腔镜或剖腹手术进行手术治疗。37例行输卵管切除术，7例行输卵管造口术，均通过腹腔镜或剖腹手术进行。
异位妊娠可通过剖腹手术、手术腹腔镜检查、药物治疗，偶尔也可仅通过观察进行处理。治疗必须根据患者的临床情况和未来生育需求进行定制。
