Toronto, ON.
Toronto, ON.
J Obstet Gynaecol Can. 2021 May;43(5):614-630.e1. doi: 10.1016/j.jogc.2021.01.002. Epub 2021 Jan 13.
To provide an evidence-based algorithm to guide the diagnosis and management of pregnancy of unknown location and tubal and nontubal ectopic pregnancy.
All patients of reproductive age.
BENEFITS, HARMS, AND COSTS: The implementation of this guideline aims to benefit patients with positive β-human chorionic gonadotropin results and provide physicians with a standard algorithm for expectant, medical, and surgical treatment of pregnancy of unknown location and tubal pregnancy and nontubal ectopic pregnancies.
The following search terms were entered into PubMed/Medline and Cochrane in 2018: cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography, and prenatal. Articles included were randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed.
The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).
Obstetrician-gynaecologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, and residents and fellows.
SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES): RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
提供循证算法以指导不明部位妊娠和输卵管及非输卵管异位妊娠的诊断和管理。
所有育龄期妇女。
获益、危害和成本：实施本指南旨在使β-人绒毛膜促性腺激素阳性的患者受益，并为医生提供一种标准算法，用于不明部位妊娠和输卵管妊娠及非输卵管异位妊娠的期待治疗、药物治疗和手术治疗。
2018 年在 PubMed/Medline 和 Cochrane 数据库中使用以下搜索词：剖宫产术、绒毛膜促性腺激素、β亚单位、人/血液、输卵管/手术、女性、生育力、人类、不孕、腹腔镜检查、甲氨蝶呤、甲氨蝶呤/给药和剂量、甲氨蝶呤/治疗用途、妊娠（腹、角、宫颈、角状、异位、异位/诊断、异位/诊断性影像学、异位/药物治疗、异位/流行病学、异位/死亡率、异位/手术、异位于、间质、峡部-宫颈、卵巢、输卵管、不明部位）、复发、危险因素、输卵管切除术、输卵管造口术、输卵管妊娠、超声检查、多普勒超声检查和产前。纳入的文章包括随机对照试验、荟萃分析、系统评价、观察性研究和病例报告。从这些文章的参考文献中还确定了其他出版物。仅对英文文献进行了审查。
作者使用推荐评估、制定和评估（GRADE）方法对证据质量和推荐强度进行评级。请参阅在线附录 A（表 A1 用于定义，表 A2 用于强推荐和弱推荐的解释）。
妇产科医师、家庭医生、急诊医师、助产士、注册护士、执业护士、医学生以及住院医师和研究员。
总结陈述（GRADE 评级用括号表示）：推荐（GRADE 评级用括号表示）。
