Does tubal ectopic pregnancy with hemoperitoneum always require surgery?
Does tubal ectopic pregnancy with hemoperitoneum always require surgery?
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DOI：
10.1002/uog.6384
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发表时间：
2009-06-01
影响因子：
7.1
通讯作者：
Condous, G.
中科院分区：
文献类型：
--
作者：
Bignardi, T.;Condous, G.
目的输卵管妊娠合并腹膜积血被认为是手术指征。这项初步研究的目的是评估非手术治疗这类妇女的可行性。对经阴道超声(TVS)发现输卵管异位妊娠和腹膜积血的患者，作为住院患者进行治疗，无论是期待治疗还是甲氨蝶呤(MTX)治疗。保守治疗的纳入标准是：依从性、临床稳定性、无急腹症、两次测量(相隔0和12-24小时)的血红蛋白水平稳定、血清人绒毛膜促性腺激素(HCG)和lt；5000IU/L、电视上无胎心活动和无明显腹膜积血，定义为血高于宫底水平和/或Morison囊(肝肾间隙)。随后的治疗以48h的hCG比率为基础。所有患者均为住院患者，直到腹痛缓解，血清hCG水平下降。结果2006年11月至2008年3月，41例输卵管妊娠患者发生输卵管妊娠。8名女性(20%)符合入围标准。诊断时的中位胎龄为49天(四分位数范围38-52.5天)。所有女性均表现为下腹痛/右髂窝或左髂窝疼痛。入院时Hb水平为11.2~14.2g/dL，12~24小时后Hb水平为12.0~14.8g/dL，6/8(75%)患者治疗效果良好，2/8(25%)患者接受MTX治疗。所有异位妊娠均在3周内消失，无并发症发生。结论超声检查发现有腹膜积血可能不是输卵管妊娠保守治疗的绝对禁忌症。版权所有(C)2009 ISUOG。作者：John Wiley&Sons，Ltd.
Objective Hemoperitoneum is accepted as an indication for surgery in women with tubal ectopic pregnancy. The aim of this pilot study was to evaluate the feasibility of managing such women non-surgically.Methods This was a prospective observational study. Women with tubal ectopic pregnancy and hemoperitoneum detected on transvaginal sonography (TVS) were managed as inpatients either expectantly or with methotrexate (MTX). Inclusion criteria for conservative management were: compliance, clinical stability, absence of acute abdomen, stable hemoglobin level on two measurements (0 and 12-24 h apart), serum human chorionic gonadotropin (hCG) < 5000 IU/L, absence of fetal cardiac activity on TVS and absence of significant hemoperitoneum, defined as blood above the level of the uterine fundus and/or in Morison's pouch (hepatorenal space). Subsequent management was based upon the hCG ratio at 48 h. All the women were managed as inpatients until the abdominal pain settled and the serum hCG levels were falling.Results Forty-one women with tubal ectopic pregnancy presented between November 2006 and March 2008. Eight women (20%) fulfilled the entry criteria. The median gestational age at diagnosis was 49 (interquartile range, 38-52.5) days. All women presented with lower abdominal pain/right iliac fossa or left iliac fossa pain. Hemoglobin levels ranged from 11.2 to 14.2 g/dL at presentation and from 12.0 to 14.8 g/dL after 12-24 h. 6/8 (75%) women were managed expectantly and 2/8 (25%) received MTX. All women bad resolution of their ectopic pregnancy within 3 weeks with no complications.Conclusions This pilot study suggests that the finding of hemoperitoneum on ultrasound examination may not be an absolute contraindication to conservative management of tubal ectopic pregnancy. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.