Tancer M L, Delke I, Veridiano N P
Surg Gynecol Obstet. 1981 Feb;152(2):179-82.
The increasing importance of an ectopic pregnancy as a cause of maternal death presents a challenge that will be met when primary care physicians combine a high index of suspicion with the ability to recognize the patient most at risk. The major symptoms, abdominal pain, secondary amenorrhea and abnormal vaginal bleeding are well known, as are the major signs, abdominal tenderness, adnexal mass and tenderness on motion of the cervix. Less well known are factors in the clinical history which indicate the patient to be at high risk. These include primary or secondary infertility, previous abortion or ectopic pregnancy and previous tubal operation, either reconstructive or sterilizing. In addition, the use of an intrauterine contraceptive device or its recent removal because of abdominal pain or bleeding, or both, is highly significant. Of major importance is a history of recent uterine evacuation. Should the diagnosis of ectopic pregnancy be under consideration, procrastination by observation is no longer acceptable. An active effort must be made to confirm or deny the diagnosis, Culdocentesis should be performed in the emergency department or clinic. If positive, prompt laparotomy is indicated. Should the result of culdocentesis be unsatisfactory or negative, laparotomy should be undertaken with further delay.
异位妊娠作为孕产妇死亡原因的重要性日益增加，这带来了一项挑战，而当基层医疗医生将高度的怀疑指数与识别高危患者的能力相结合时，这一挑战将得以应对。主要症状，如腹痛、继发性闭经和异常阴道出血，以及主要体征，如腹部压痛、附件肿块和宫颈举痛，都是众所周知的。临床病史中表明患者处于高危状态的因素则不太为人所知。这些因素包括原发性或继发性不孕、既往流产或异位妊娠以及既往输卵管手术，无论是重建手术还是绝育手术。此外，使用宫内节育器或因腹痛或出血（或两者兼有）而近期取出宫内节育器，具有高度的重要性。近期子宫排空史至关重要。如果考虑异位妊娠的诊断，通过观察拖延已不再可行。必须积极努力以证实或排除诊断，应在急诊科或诊所进行后穹窿穿刺。如果结果为阳性，则应立即进行剖腹手术。如果后穹窿穿刺结果不理想或为阴性，应进一步延迟后进行剖腹手术。
