Cowan B D
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
Curr Opin Obstet Gynecol. 1993 Jun;5(3):328-32.
The incidence of ectopic pregnancy in the United States is increasing annually and is approaching epidemic proportions. Serum progesterone measurements show promise for the early detection of abnormal gestational development. Unfortunately, examination of serum progesterone levels does not allow discrimination between an ectopic pregnancy and an intrauterine abortion. Additionally, discriminatory levels of progesterone fail to include all abnormal gestations in the abnormal group (false-negative result) and classify some normal pregnancies to the abnormal group (false-positive result). As such, no discriminatory level of progesterone has been identified that can diagnose abnormal gestations. Instead, the value of progesterone appears to be its ability to predict a gestational complication, in much the same fashion as human chorionic gonadotropin doubling times. The advantage of progesterone appears to be that a single test of serum progesterone during the first 8 weeks of pregnancy is as predictive as serial human chorionic gonadotropin measurements. Clearly, future investigations into early gestational complications will focus on testing procedures that can discriminate between an intrauterine first-trimester demise and an ectopic pregnancy. Medical treatment for ectopic pregnancy is dependent on early diagnosis and is not yet widespread. Prostaglandin F2 alpha and methotrexate continue to be effective agents and demonstrate approximately 95% efficacy. Reproductive performance after medical therapy is comparable to reproductive performance after surgical therapy, but the duration of time until cure is longer in patients treated medically than in those treated surgically. Nomograms for human chorionic gonadotropin surveillance after surgical treatment have now been described, but not such data exists for surveillance after medical therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
美国宫外孕的发病率逐年上升，正接近流行程度。血清孕酮检测有望早期发现异常妊娠发育。不幸的是，检测血清孕酮水平无法区分宫外孕和宫内流产。此外，孕酮的鉴别水平未能将所有异常妊娠纳入异常组（假阴性结果），并将一些正常妊娠归类为异常组（假阳性结果）。因此，尚未确定能诊断异常妊娠的孕酮鉴别水平。相反，孕酮的价值似乎在于其预测妊娠并发症的能力，这与人类绒毛膜促性腺激素倍增时间的方式非常相似。孕酮的优势似乎在于，在妊娠的前8周进行一次血清孕酮检测与连续检测人类绒毛膜促性腺激素一样具有预测性。显然，未来对早期妊娠并发症的研究将集中在能够区分宫内孕早期死亡和宫外孕的检测程序上。宫外孕的药物治疗依赖于早期诊断，目前尚未广泛应用。前列腺素F2α和甲氨蝶呤仍然是有效的药物，疗效约为95%。药物治疗后的生殖性能与手术治疗后的生殖性能相当，但药物治疗患者的治愈时间比手术治疗患者更长。现已描述了手术治疗后人绒毛膜促性腺激素监测的列线图，但药物治疗后监测尚无此类数据。（摘要截短至250字）
