Hinney B, Bertagnoli C, Tobler-Sommer M, Osmers R, Wuttke W, Kuhn W
Department of Obstetrics and Gynecology, University of Göttingen, Germany.
Ultrasound Obstet Gynecol. 1995 Apr;5(4):260-6. doi: 10.1046/j.1469-0705.1995.05040260.x.
In patients suspected of having an ectopic pregnancy, because of a positive beta-human chorionic gonadotropin (beta-hCG) test and a sonographically undetectable gestational sac, even laparoscopy cannot always achieve a precise diagnosis, when the gestational age is very early. This means that the patient has to be followed by repeated beta-hCG measurements and repeated laparoscopy, which are expensive and inconvenient for the patient. This paper reports on a method that is simple to perform and that will provide the clinician with valuable information about the strong likelihood of a tubal pregnancy when ultrasound and beta-hCG measurements raise the suspicion but are not diagnostic. A prerequisite for this approach is the availability of a minimal volume (1-2 ml) of peritoneal fluid in the pouch of Douglas. A total of 131 patients who had a positive beta-hCG test and an undetectable gestational sac within the uterine cavity and who had a small volume of cul-de-sac fluid were studied. The fluid was obtained transvaginally by means of an ultrasound-guided automatic puncture system. The beta-hCG level was determined in the cul-de-sac fluid and in the maternal serum, for comparison. In two cases with tubal pregnancy, concentrated viscous blood samples were aspirated and beta-hCG concentrations could not be measured for technical reasons. In 129 cases, the ratio of levels of beta-hCG between serum and cul-de-sac fluid could be measured. In 42 out of 44 patients with intrauterine pregnancy, the ratio was greater than unity; in 82 out of 85 patients with a tubal pregnancy, the ratio was less than unity. With this ratio used for detection of tubal pregnancy, the diagnostic sensitivity of the test was 95.4% and the specificity was 95.2%. The positive predictive value was 97.6% and the negative predictive value 91.3%. We conclude from these findings that the measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio facilitated the early diagnosis of an ectopic pregnancy in the Fallopian tube.
对于疑似异位妊娠的患者，由于β-人绒毛膜促性腺激素（β-hCG）检测呈阳性且超声检查未发现妊娠囊，即使在孕周非常早的时候，腹腔镜检查也并非总能做出准确诊断。这意味着患者必须接受多次β-hCG测量和多次腹腔镜检查，这对患者来说既昂贵又不方便。本文报道了一种操作简单的方法，当超声检查和β-hCG测量引起怀疑但不能确诊时，该方法能为临床医生提供关于输卵管妊娠可能性很大的有价值信息。这种方法的一个前提是道格拉斯窝内有最少1 - 2毫升的腹腔液。共研究了131例β-hCG检测呈阳性、宫腔内未发现妊娠囊且道格拉斯窝内有少量液体的患者。通过超声引导自动穿刺系统经阴道获取液体。测定腹腔液和母血中的β-hCG水平以作比较。在2例输卵管妊娠病例中，抽出的是浓缩的粘性血液样本，因技术原因无法测量β-hCG浓度。在129例病例中，可以测量血清和腹腔液中β-hCG水平的比值。44例宫内妊娠患者中有42例该比值大于1；85例输卵管妊娠患者中有82例该比值小于1。用这个比值检测输卵管妊娠，该检测的诊断敏感性为95.4%，特异性为95.2%。阳性预测值为97.6%，阴性预测值为91.3%。我们从这些研究结果得出结论，测定母血与腹腔液β-hCG比值有助于早期诊断输卵管异位妊娠。
