Dart R G, Kaplan B, Cox C
Department of Emergency Medicine, Boston Medical Center, MA 02118, USA.
Ann Emerg Med. 1997 Aug;30(2):135-40. doi: 10.1016/s0196-0644(97)70131-8.
To determine how often pelvic ultrasonography diagnoses or excludes ectopic pregnancy (EP) in patients who present with abdominal pain or vaginal bleeding and a beta-human chorionic gonadotropin (beta-hCG) level lower than 1,000 mIU/mL.
This was a retrospective chart review of all patients who presented to the ED of an urban teaching hospital from August 1991 through July 1995 with lower abdominal pain or bleeding, a positive beta-hCG assay, and a quantitative beta-hCG value lower than 1,000 mIU/mL in whom pelvic transvaginal ultrasound was performed within 24 hours of the ED visit. Ultrasound procedures were performed in the radiology department by ultrasound technicians under the direct supervision of an attending radiologist or resident in radiology. Patients were excluded if they had recently delivered or undergone dilatation and curettage, had had a previous ultrasound examination during this pregnancy, had decreasing beta-hCG values, or were lost to follow-up before a definitive diagnosis was made.
: A total of 111 patients met the inclusion criteria; 19 patients (17%; 95% confidence interval [CI], 10% to 24%) had diagnostic ultrasound findings. Of these, 10 findings were diagnostic of intrauterine pregnancy and 9 for EP. The beta-hCG values for the patients with diagnostic examinations ranged from 47 to 995 mIU/mL. Twenty-three study patients ultimately received a diagnosis of EP; of these, 9 (39%; CI, 19% to 59%) had a diagnostic initial ultrasound study. Five of the nine had beta-hCG values lower than 500 mIU/mL.
Approximately one third of women with EP who present with beta-hCG values lower than 1,000 mIU/mL were identified with an urgent transvaginal ultrasound examination performed by trained ultrasound technicians. Clinicians should consider the use of pelvic ultrasound in patients with suspected EP, regardless of their beta-hCG values, particularly at institutions where ultrasound is readily available.
确定对于出现腹痛或阴道出血且β-人绒毛膜促性腺激素（β-hCG）水平低于1000 mIU/mL的患者，盆腔超声检查诊断或排除异位妊娠（EP）的频率。
这是一项对1991年8月至1995年7月期间到一家城市教学医院急诊科就诊的所有患者的回顾性病历审查，这些患者有下腹痛或出血、β-hCG检测呈阳性且定量β-hCG值低于1000 mIU/mL，并在急诊科就诊后24小时内进行了经阴道盆腔超声检查。超声检查由超声技师在放射科主治医师或放射科住院医师的直接监督下进行。如果患者近期分娩或接受过刮宫术、此次妊娠期间曾接受过超声检查、β-hCG值下降或在做出明确诊断前失访，则将其排除。
共有111例患者符合纳入标准；19例患者（17%；95%置信区间[CI]，10%至24%）有诊断性超声检查结果。其中，10例检查结果诊断为宫内妊娠，9例为异位妊娠。进行诊断性检查的患者的β-hCG值范围为47至995 mIU/mL。23例研究患者最终被诊断为异位妊娠；其中9例（39%；CI，19%至59%）在初次超声检查时有诊断性结果。9例中的5例β-hCG值低于500 mIU/mL。
约三分之一β-hCG值低于1000 mIU/mL的异位妊娠女性患者可通过由训练有素的超声技师进行的紧急经阴道超声检查得以确诊。临床医生应考虑对疑似异位妊娠的患者使用盆腔超声，无论其β-hCG值如何，尤其是在超声设备易于获取的机构。
