Stabile I, Campbell S, Grudzinskas J G
Academic Unit of Obstetrics and Gynaecology, London Hospital Medical College.
Br J Obstet Gynaecol. 1988 Dec;95(12):1247-52. doi: 10.1111/j.1471-0528.1988.tb06813.x.
A total of 252 women with amenorrhoea and with abdominal pain or vaginal bleeding, or both, had an emergency high-resolution ultrasound sector scan. In 100 women the symptoms were unrelated to any identifiable abnormal ultrasound finding, none of them was pregnant and their symptoms settled spontaneously; 33 other women had follicular or luteal cysts and 30 had pelvic inflammatory disease. Histological examination confirmed an ectopic pregnancy in 60 women (24%); in seven a live fetus was observed outside the uterus allowing a confident diagnosis of ectopic pregnancy; in 27 the thickness of the endometrium was greater than 10 mm (sensitivity 50%, specificity 84%, positive predictive value 28%, negative predictive value 87%); in 15 the uterine area measurement was less than 20 cm2 (sensitivity 72%, specificity 41%, positive predictive value 20%, negative predictive value 79%); and 43 had an adnexal mass volume greater than 10 ml separate from the ovary (sensitivity 85%, specificity 37%, positive predictive value 23%, negative predictive value 90%). Only three had negative ultrasound findings. The negative predictive value of an ultrasound examination could be increased to 96% by using a combination of these ultrasound features. The addition of hCG (greater than 25 i.u./l) improved the specificity to 98% and the negative predictive value to 100%. These criteria may improve the ultrasound diagnosis of ectopic pregnancy.
共有252名闭经且伴有腹痛或阴道出血（或两者皆有）的女性接受了急诊高分辨率超声扇形扫描。100名女性的症状与任何可识别的超声异常发现无关，她们均未怀孕，症状自行缓解；另外33名女性有卵泡或黄体囊肿，30名有盆腔炎。组织学检查证实60名女性（24%）为异位妊娠；其中7名在子宫外观察到活胎，可确诊为异位妊娠；27名女性的子宫内膜厚度大于10毫米（敏感性50%，特异性84%，阳性预测值28%，阴性预测值87%）；15名女性的子宫面积测量值小于20平方厘米（敏感性72%，特异性41%，阳性预测值20%，阴性预测值79%）；43名女性有一个与卵巢分开的附件包块，体积大于10毫升（敏感性85%，特异性37%，阳性预测值23%，阴性预测值90%）。只有3名女性超声检查结果为阴性。通过综合这些超声特征，超声检查的阴性预测值可提高到96%。加上人绒毛膜促性腺激素（大于25国际单位/升）后，特异性提高到98%，阴性预测值提高到100%。这些标准可能会改善异位妊娠的超声诊断。
