Loh Wei-Guo Nicholas, Adno Alan Maurice, Reid Shannon
Department of Obstetrics and Gynaecology Liverpool Hospital Sydney New South Wales Australia.
South Western Sydney Clinical School University of New South Wales Sydney New South Wales Australia.
Australas J Ultrasound Med. 2022 Aug 3;25(4):166-175. doi: 10.1002/ajum.12312. eCollection 2022 Nov.
Non-tubal ectopic pregnancy (NTEP) is a rare but significant early pregnancy complication which can result in maternal morbidity and mortality. There is however a lack of evidence-based guidelines for the management of NTEP.
To evaluate the success rates of expectant, medical and surgical management in the treatment of NTEP at our tertiary centre.
Retrospective cohort study from 2010 to 2020. All NTEP were classified by ectopic sites. Primary management was classified by expectant, medical [systemic methotrexate (Sys-MTX) and/or local ultrasound-guided injection of MTX and/or KCl intra-sac (L-MTX, L-MTX/KCl)] or surgical. Primary management was considered successful if no change in intervention was required. Treatment complications were compared.
Twenty-four NTEP were identified, which included 14 interstitial pregnancies (IP), 9 caesarean scar pregnancies (CSP) and 1 ovarian pregnancy (OP), which gave NTEP an incidence of 7.12% among all EP (4.15% for IP, 2.67% for CSP and 0.30% for OP). The success of primary surgical management was 100% (7/7), primary medical management was 76.9% (10/13) and primary expectant management was 33.3% (1/3). Primary medical management had a non-statistically significant greater mean time to serum ß-human Chorionic Gonadotrophin <5 IU/L, mean length of hospitalisation, mean number of follow-up visits and hospital re-presentation/readmissions compared to primary surgical management. There was no other difference in complication rates between the treatment management groups.
Surgery remains the most effective way to manage NTEP. However, medical management can be a safe and effective alternative option in carefully selected cases.
非输卵管异位妊娠（NTEP）是一种罕见但严重的早期妊娠并发症，可导致孕产妇发病和死亡。然而，目前缺乏关于NTEP管理的循证指南。
评估在我们的三级中心，期待治疗、药物治疗和手术治疗NTEP的成功率。
对2010年至2020年进行回顾性队列研究。所有NTEP均按异位部位分类。初始治疗分为期待治疗、药物治疗[全身用甲氨蝶呤（Sys-MTX）和/或局部超声引导下向孕囊内注射甲氨蝶呤和/或氯化钾（L-MTX、L-MTX/KCl）]或手术治疗。如果无需改变干预措施，则初始治疗被视为成功。比较治疗并发症。
共识别出24例NTEP，其中包括14例间质部妊娠（IP）、9例剖宫产瘢痕妊娠（CSP）和1例卵巢妊娠（OP），NTEP在所有异位妊娠中的发生率为7.12%（IP为4.15%，CSP为2.67%，OP为0.30%）。初始手术治疗的成功率为100%（7/7），初始药物治疗为76.9%（10/13），初始期待治疗为33.3%（1/3）。与初始手术治疗相比，初始药物治疗至血清β-人绒毛膜促性腺激素<5 IU/L的平均时间、平均住院时间、平均随访次数及再次入院/住院的差异无统计学意义。治疗组之间的并发症发生率无其他差异。
手术仍然是治疗NTEP最有效的方法。然而，在精心挑选的病例中，药物治疗可以是一种安全有效的替代选择。
