Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Emerg Med. 2022 Feb;52:50-53. doi: 10.1016/j.ajem.2021.11.025. Epub 2021 Nov 19.
A comparative examination of the clinical, laboratory, ultrasound findings, and operative characteristics of rare site located ectopic pregnancies.
Retrospective analysis of all department cases of rare site located ectopic pregnancies diagnosed and treated from December 2006 to December 2019.
Thirty rare ectopic pregnancies were identified. Of these, 11 were ovarian, 10 were interstitial and 9 were tubal stump. The patients treated for ovarian pregnancy had significantly lower human chorionic gonadotropin (hCG) levels than patients treated for interstitial or stump pregnancies (2025 ± 1105 mIU/ml, 18,424 ± 2579 mIU/ml and 11,204 ± 9221 mIU/ml, respectively, p = 0.003). The main presenting symptom in patients with an ovarian pregnancy was abdominal pain (90.9%, 60.0% and 44.4%, respectively, p = 0.031). Signs of abdominal peritoneal irritation (i.e., rebound tenderness and guarding) were more frequent upon physical examination in patients with an ovarian pregnancy (72.2%, 30.0% and 22.2%, respectively, p = 0.044) who also exhibited the highest rates of syncope and hypovolemic shock upon admission compared to patients with an interstitial or stump pregnancy (54.5%, 10.0% and 11.1%, respectively, p = 0.031). Ovarian pregnancies were associated with the lowest sonographic detection rates (9.1%, 80.0% and 100%, respectively, p = 0.0001) and with free fluid in the pouch of Douglas (72.7%, 20.0% and 22.2%, respectively, p = 0.02). Ovarian pregnancies experienced the highest rupture rate during surgery compared to interstitial or stump pregnancies (66.9%, 16.7% and 44.4%, respectively, p = 0.028), had a significantly higher estimated blood loss (1081 ± 647 ml, 760 ± 597 ml and 343 ± 318 ml, respectively, p = 0.003) and required blood transfusions in the perioperative period (63.6%, 20.0% and 11.1%, respectively, p = 0.025) significantly more often.
Ovarian pregnancy remains the most challenging diagnosis compared to interstitial and tubal stump ectopic's. Health care providers should recognize these rare site ectopic pregnancies and to handle these gynecological emergencies promptly.
比较罕见部位异位妊娠的临床、实验室、超声表现和手术特点。
回顾性分析 2006 年 12 月至 2019 年 12 月期间诊断和治疗的所有罕见部位异位妊娠的科室病例。
确定了 30 例罕见的异位妊娠。其中，11 例为卵巢妊娠，10 例为间质妊娠，9 例为输卵管残端妊娠。接受卵巢妊娠治疗的患者 hCG 水平明显低于接受间质妊娠或残端妊娠治疗的患者（分别为 2025±1105 mIU/ml、18424±2579 mIU/ml 和 11204±9221 mIU/ml，p=0.003）。卵巢妊娠患者的主要表现症状为腹痛（分别为 90.9%、60.0%和 44.4%，p=0.031）。接受卵巢妊娠治疗的患者体格检查时腹部腹膜刺激征（即反跳痛和肌紧张）更为频繁（分别为 72.2%、30.0%和 22.2%，p=0.044），且与间质妊娠或残端妊娠患者相比，入院时晕厥和低血容量性休克的发生率更高（分别为 54.5%、10.0%和 11.1%，p=0.031）。卵巢妊娠的超声检出率最低（分别为 9.1%、80.0%和 100%，p=0.0001），Douglas 窝内有游离液（分别为 72.7%、20.0%和 22.2%，p=0.02）。与间质妊娠或残端妊娠相比，卵巢妊娠术中破裂率最高（分别为 66.9%、16.7%和 44.4%，p=0.028），估计出血量明显更高（分别为 1081±647 ml、760±597 ml 和 343±318 ml，p=0.003），围手术期需要输血的比例也更高（分别为 63.6%、20.0%和 11.1%，p=0.025）。
与间质妊娠和输卵管残端妊娠相比，卵巢妊娠仍然是最具挑战性的诊断。医疗保健提供者应认识到这些罕见部位的异位妊娠，并迅速处理这些妇科急症。
