Bello G V, Schonholz D, Moshirpur J, Jeng D Y, Berkowitz R L
Obstet Gynecol Surv. 1986 Oct;41(10):603-13.
Nine recent cases of coexisting intra- and extrauterine pregnancy at The Mount Sinai Medical Center are presented. The myriad of clinical presentations is exemplified in the postabortal, endometriosis, posttreatment; ovulation induction, and routine "rule-out ectopic" situations. A brief review of the literature follows detailing historical reports of diagnostic inaccuracy and delayed diagnosis. Several studies are cited supporting the difficulty of correctly diagnosing heterotopic pregnancy as well as factors which may predispose to it. The advantages and pitfalls of ultrasonography are mentioned as well as recommendations for early laparoscopic intervention when clinical history and ultrasound are suggestive. Caution is advised in those infertility patients who may undergo "routine" curettage at laparoscopy for ectopic pregnancy and thus, be at risk for inadvertent termination of an otherwise salvageable intrauterine pregnancy. This report further supports several other reviews in noting that the incidence of combined pregnancy may be much greater than formerly appreciated.
本文介绍了西奈山医疗中心近期收治的9例宫内宫外同时妊娠的病例。各种临床表现体现在流产后、子宫内膜异位症、治疗后、促排卵以及常规“排除异位妊娠”的情况中。随后对文献进行了简要回顾，详细介绍了诊断不准确和诊断延迟的历史报告。引用了几项研究，支持正确诊断异位妊娠的困难以及可能导致异位妊娠的因素。提到了超声检查的优点和缺陷，以及当临床病史和超声检查提示时早期腹腔镜干预的建议。对于那些可能在腹腔镜检查时因异位妊娠而接受“常规”刮宫术的不孕症患者，建议谨慎操作，因为这可能会无意中终止原本可挽救的宫内妊娠。本报告进一步支持了其他几项综述，指出合并妊娠的发生率可能比以前认为的要高得多。
