Department of Obstetrics and Gynecology, Boston Medical Center, and the School of Public Health, Boston University, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York; the Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico; and the Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts.
Obstet Gynecol. 2021 Jul 1;138(1):33-41. doi: 10.1097/AOG.0000000000004423.
To investigate published cases of cervical ectopic pregnancy between 2000 and 2018 and compare management strategies and treatment success rates based on initial patient characteristics.
PubMed, EMBASE, and Web of Science were searched to capture peer-reviewed citations published between 2000 and 2018. Cases reporting either β-hCG level, crown-rump length, or gestational sac diameter for each individual patient were included. Data regarding the article information, patient characteristics, treatment used, and outcomes were collected. Initial success was defined as resolution of the cervical ectopic pregnancy with the predefined treatment plan. Initial failure was defined as the requirement of additional unplanned interventions due to the predefined treatment plan not being successful. End success was defined as resolution of the cervical ectopic pregnancy without hysterectomy.
A total of 204 articles from 44 countries comprising 454 cases were reviewed. The initial β-hCG level ranged from 9 to 286,500, with a median of 14,773, and gestational age ranged from 4 to 18 weeks, with an average of 7 4/7 weeks (±2 0/7 weeks). In looking at initial success, compared with methotrexate alone, dilation, and curettage (odds ratio [OR] 2.26; 95% CI 2.64-10.45), dilation and curettage combined with uterine artery embolization (OR 4.85; 95% CI 2.06-11.44) and uterine artery embolization (OR 5.17; 95% CI 1.14-23.53) were more effective options. More than half of patients (50.2%) required multiple interventions, and 41 (9%) resulted in hysterectomy.
Management of cervical ectopic pregnancies should be guided by patient stability, β-hCG level, size of pregnancy, and fetal cardiac activity but may benefit from a planned multimodal approach.
调查 2000 年至 2018 年间发表的宫颈妊娠病例，并根据初始患者特征比较管理策略和治疗成功率。
检索了 PubMed、EMBASE 和 Web of Science 中的同行评审文献，以获取 2000 年至 2018 年期间发表的文献。纳入报告每位患者的β-hCG 水平、头臀长或妊娠囊直径的病例。收集有关文章信息、患者特征、治疗方法和结果的数据。初始成功定义为采用既定治疗方案后宫颈妊娠得到解决。初始失败定义为由于既定治疗方案不成功而需要进行额外的非计划干预。最终成功定义为无需行子宫切除术即可解决宫颈妊娠。
共复习了来自 44 个国家的 204 篇文章，共 454 例。初始β-hCG 水平范围为 9 至 286500mIU/ml，中位数为 14773mIU/ml，妊娠龄范围为 4 至 18 周，平均 7 4/7 周（±2 0/7 周）。就初始成功率而言，与单独使用甲氨蝶呤相比，扩张和刮宫术（比值比[OR]2.26；95%CI 2.64-10.45）、扩张和刮宫术联合子宫动脉栓塞术（OR 4.85；95%CI 2.06-11.44）和子宫动脉栓塞术（OR 5.17；95%CI 1.14-23.53）是更有效的选择。超过一半的患者（50.2%）需要进行多次干预，41 例（9%）导致子宫切除术。
宫颈妊娠的处理应根据患者的稳定性、β-hCG 水平、妊娠大小和胎儿心脏活动来指导，但可能受益于计划的多模式方法。
