Department of Obstetrics and Gynecology, Angers University Hospital, 4 rue Larrey, Angers 49100, France.
Department of Obstetrics and Gynecology, Tenon Hospital, Paris, France.
J Gynecol Obstet Hum Reprod. 2022 Apr;51(4):102330. doi: 10.1016/j.jogoh.2022.102330. Epub 2022 Feb 26.
Non-tubal ectopic pregnancies (NTEP) in France constitute approximately 5% of ectopic pregnancies (EP). A NTEP can be abdominal, ovarian, cervical, interstitial, on a caesarean scar, or cornual. These pregnancies, which are sometimes difficult to diagnose and are often diagnosed late, carry a high risk of complications, particularly haemorrhages. Many treatments have been described for treating these NTEP. Our objective is to assess how they are cared for in terms of diagnosis, treatment and monitoring.
An online questionnaire was sent out to all members of the French Society of gynecologic and Pelvic Surgery (SCGP) in September 2020. The questionnaire was in the form of two clinical cases on interstitial and caesarean scar pregnancies.
141 SCGP members responded (36%). For diagnosis, 58% of respondents enlisted the help of a specialist sonographer. MRI is rarely used for diagnosis to the extent that it was only requested in 7% of cases for interstitial pregnancy and 23.6% of cases for caesarean scar pregnancy. In the case of stable interstitial pregnancy without signs of complications, treatment is predominantly medical (90%), with the use of methotrexate (MTX) by intramuscular injection in 33.3% of cases, by in situ injection in 30.7% of cases, or a combination of the two in 36% of cases. If there were signs of pre-rupture, the majority of respondents performed laparoscopic surgical treatment (79.3%). In terms of caesarean scar pregnancies, the treatment was predominantly medical (78.2%) with the use of MTX only, as an intramuscular injection in 23.3% of cases, in situ in 36% of cases, and as a combination of intramuscular and in situ in 37.2% of cases.
Non-tubal ectopic pregnancies are sometimes difficult to diagnose in the first trimester and constitute a significant haemorrhage risk for patients. In France, there is currently no specific recommendation on this subject and there is huge disparity in practice.
法国的非输卵管异位妊娠（NTEP）约占异位妊娠（EP）的 5%。NTEP 可以是腹部、卵巢、宫颈、间质、剖宫产瘢痕或角部的妊娠。这些妊娠有时难以诊断，且常常被诊断得较晚，存在很高的并发症风险，尤其是出血。已经描述了许多治疗方法来治疗这些 NTEP。我们的目的是评估在诊断、治疗和监测方面如何对其进行治疗。
2020 年 9 月，向法国妇科和骨盆外科学会（SCGP）的所有成员发送了一份在线问卷。问卷以间质和剖宫产瘢痕妊娠的两个临床病例的形式呈现。
141 名 SCGP 成员做出了回应（36%）。在诊断方面，58%的受访者求助于专业超声科医生。MRI 很少用于诊断，以至于在间质妊娠中仅在 7%的情况下请求，在剖宫产瘢痕妊娠中仅在 23.6%的情况下请求。对于没有并发症迹象的稳定间质妊娠，治疗主要是药物治疗（90%），在 33.3%的情况下使用肌肉内注射甲氨蝶呤（MTX），在 30.7%的情况下使用原位注射，在 36%的情况下两者联合使用。如果有破裂前的迹象，大多数受访者进行腹腔镜手术治疗（79.3%）。对于剖宫产瘢痕妊娠，治疗主要是药物治疗（78.2%），仅使用 MTX，在 23.3%的情况下作为肌肉内注射，在 36%的情况下作为原位注射，在 37.2%的情况下作为肌肉内和原位联合注射。
非输卵管异位妊娠在妊娠早期有时难以诊断，对患者存在很大的出血风险。在法国，目前对此没有具体的建议，实践中存在很大的差异。
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