Barnhart K, Mennuti M T, Benjamin I, Jacobson S, Goodman D, Coutifaris C
Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia.
Obstet Gynecol. 1994 Dec;84(6):1010-5.
To evaluate quantitative hCG measurements and transvaginal ultrasound in the diagnosis of ectopic pregnancy in patients presenting to the emergency department.
A discriminatory zone for detecting the presence or absence of an intrauterine pregnancy by transvaginal ultrasound was established prospectively. Women presenting to the emergency department were evaluated prospectively using a diagnostic algorithm consisting of clinical examination, quantitative serum hCG, and transvaginal ultrasound. Finally, ectopic pregnancies diagnosed over a 22-month period were evaluated prospectively.
All viable intrauterine pregnancies were identified in those subjects with hCG levels of 1500 mIU/mL (First International Reference) or greater. One thousand two hundred sixty-three subjects were evaluated prospectively; 59.8% were diagnosed with intrauterine pregnancy, 26.8% with spontaneous abortion, and 7.8% with ectopic pregnancy. At presentation, 13.2% of intrauterine pregnancies were diagnosed by clinical examination, whereas 82.9% were diagnosed by transvaginal ultrasound. Only 4% of normal intrauterine pregnancies were not confirmed on initial visit. Of 205 ectopic pregnancies diagnosed, 81.5% were hemodynamically stable; of these, 49.1% were diagnosed on initial presentation. Of all ectopics, 59% never reached an hCG level of 1500 mIU/mL and 35.8% had an hCG lower than the level at presentation. This protocol diagnosed ectopic pregnancies with a sensitivity of 100% and a specificity of 99.9%.
A protocol of quantitative hCG levels (available within hours of presentation to an emergency department) combined with transvaginal ultrasound is effective in diagnosing ectopic pregnancy.
评估定量人绒毛膜促性腺激素（hCG）检测及经阴道超声检查在急诊科就诊患者异位妊娠诊断中的应用价值。
前瞻性地建立经阴道超声检测宫内妊娠存在与否的鉴别阈值。前瞻性地对急诊科就诊的女性患者采用由临床检查、定量血清hCG检测及经阴道超声检查组成的诊断算法进行评估。最后，对22个月期间诊断出的异位妊娠进行前瞻性评估。
在hCG水平达到1500 mIU/mL（第一国际参考值）及以上的患者中识别出了所有存活的宫内妊娠。前瞻性地评估了1263例患者；59.8%被诊断为宫内妊娠，26.8%为自然流产，7.8%为异位妊娠。就诊时，13.2%的宫内妊娠通过临床检查诊断，而82.9%通过经阴道超声诊断。初次就诊时仅4%的正常宫内妊娠未得到确诊。在诊断出的205例异位妊娠中，81.5%血流动力学稳定；其中，49.1%在初次就诊时被诊断出来。在所有异位妊娠中，59%的hCG水平从未达到1500 mIU/mL，35.8%的hCG水平低于就诊时的水平。该方案诊断异位妊娠的敏感性为100%，特异性为99.9%。
定量hCG水平（在急诊科就诊后数小时内即可获得）联合经阴道超声检查方案在诊断异位妊娠方面有效。
