Durham B, Lane B, Burbridge L, Balasubramaniam S
Department of Emergency Medicine, Martin Luther King-Los Angeles County Medical and Trauma Center, California, USA.
Ann Emerg Med. 1997 Mar;29(3):338-47. doi: 10.1016/s0196-0644(97)70345-7.
To determine the accuracy and application of pelvic ultrasound performed by emergency physicians in detecting ectopic pregnancy (EP) in complicated first-trimester pregnancies.
We studied consecutive pelvic ultrasounds performed in all women who presented with abdominal pain or vaginal bleeding during the first trimester of pregnancy over a 6-month period. Patients with clinical evidence of incomplete abortion were not included. We compared ultrasound results with subsequent ultrasound findings by the radiology department and correlated them with follow-up diagnoses and outcomes.
Of the 136 eligible patients, a final diagnosis was rendered in 125; 11 were lost to follow-up. These ED ultrasound findings were recorded: established intrauterine pregnancy (IUP) with embryonic structures, 87 (70%); indeterminate scan revealing no distinct evidence of IUP or EP, 15 (12%); early intrauterine gestational sac of less than 6 weeks without embryonic structures, 12 (10%); EP, 8 (6%); blighted ovum, 2 (2%); and molar pregnancy, 1 (1%). The initial ED ultrasound determination was consistent with radiology department findings, final outcome, or both in 121 (96%) (95% confidence interval [CI], 91% to 97%). ED ultrasound accurately identified 87 pregnancies with intrauterine embryonic structures, including 5 patients with fetal demise (95% Cl, 97% to 100%). Diagnosis of pregnancy location in these 87 patients effectively ruled out EP, with a negative predictive value of 100%. The sensitivity and specificity of ED ultrasound in the detection of EP were 90% and 88%, respectively.
Pelvic ultrasonography performed by emergency physicians can be used to rule out EP and make an accurate diagnosis in most patients with complicated first-trimester pregnancies during the initial ED visit. The remaining patients at risk can be identified and a diagnosis made by means of follow-up ultrasound and serial hCG determinations.
确定急诊医生进行盆腔超声检查在检测妊娠早期复杂妊娠中的异位妊娠（EP）时的准确性及应用情况。
我们研究了在6个月期间内，所有在妊娠早期出现腹痛或阴道出血的女性所进行的连续盆腔超声检查。不包括有不完全流产临床证据的患者。我们将超声检查结果与放射科随后的超声检查结果进行比较，并将它们与后续诊断及结果相关联。
在136名符合条件的患者中，125名获得了最终诊断；11名失访。记录了这些急诊超声检查结果：有胚胎结构的确诊宫内妊娠（IUP），87例（70%）；扫描结果不确定，未发现IUP或EP的明显证据，15例（12%）；小于6周且无胚胎结构的早期宫内妊娠囊，12例（10%）；EP，8例（6%）；枯萎卵，2例（2%）；葡萄胎，1例（1%）。急诊超声的初始判定与放射科检查结果、最终结局或两者均一致的有121例（96%）（95%置信区间[CI]，91%至97%）。急诊超声准确识别出87例有宫内胚胎结构的妊娠，包括5例胎儿死亡患者（95%CI，97%至100%）。这87例患者中妊娠位置的诊断有效地排除了EP，阴性预测值为1百%。急诊超声检测EP的敏感性和特异性分别为90%和88%。
急诊医生进行的盆腔超声检查可用于排除EP，并在大多数妊娠早期复杂妊娠患者的初次急诊就诊时做出准确诊断。其余有风险的患者可通过后续超声检查和连续hCG测定来识别并做出诊断。
