PDF(Pubmed)
Abstract：
An ectopic pregnancy (EP) occurs when the fertilised ovum implants outside the endometrial cavity. An EP has an incidence of 1%, with the majority occurring in the fallopian tube. It has a maternal mortality of 0.2 per 1000, with about two-thirds of these deaths associated with substandard care. An interstitial pregnancy occurs when the EP implants in the interstitial part of the fallopian tube. An interstitial ectopic pregnancy (IEP) shows few early clinical symptoms, hence it is associated with serious or fatal bleeding and a mortality rate up to 2.5%. With the advent of transvaginal ultrasound scan (TV USS), correlated with serum beta human chorionic gonadotropin (BHCG) assay, earlier diagnosis of an EP can be established. An EP is often diagnosed in women who are trying to conceive; therefore, the prognosis of future fertility is one of the main concerns associated with this diagnosis. Management can be surgical, expectant or medical with methotrexate (MTX). However, the best approach is tailored to the woman\'s individual case. The authors present the case of a primigravida woman presenting with abdominal pain and vaginal bleeding at 6 weeks gestation following assisted reproduction. Her BHCG showed a suboptimal rise. Her TV USS showed no evidence of an intrauterine pregnancy. There was no evidence of an adnexal mass or free fluid. As her BHCG remained static, she underwent a diagnostic laparoscopy. A right sided IEP was identified. Due to the high risk of bleeding requiring transfusion or hysterectomy and her desire to preserve her fertility, she received medical management with MTX. Indeed, research has shown that women successfully managed expectantly achieve better reproductive outcomes, with the shortest time to achieve a subsequent intrauterine pregnancy. This case acts as a cautionary reminder of the challenges associated with identifying an IEP on TV USS. A high index of clinical suspicion is required to prevent maternal morbidity and mortality.
摘要：
当受精卵植入子宫内膜腔外时，就会发生异位妊娠（EP）。EP的发生率为1%，大部分发生在输卵管。它的孕产妇死亡率为每千人0.2例，其中约三分之二的死亡与不合格的护理有关。当EP植入输卵管间质部分时发生间质妊娠。间质性异位妊娠（IEP）显示很少的早期临床症状，因此，它与严重或致命的出血有关，死亡率高达2.5％。随着经阴道超声扫描（TVUSS）的出现，与血清β人绒毛膜促性腺激素（BHCG）测定相关，可以建立EP的早期诊断。EP通常在试图怀孕的女性中被诊断出来；因此，未来生育力的预后是与该诊断相关的主要问题之一.管理可以是手术，甲氨蝶呤（MTX）的期待或医疗。然而,最好的方法是针对女性的个别情况。作者介绍了一名初产妇在辅助生殖后妊娠6周时出现腹痛和阴道出血的情况。她的BHCG显示出次优的上升。她的电视USS没有显示宫内妊娠的证据。没有附件质量或游离液的证据。当她的BHCG保持静止时，她接受了诊断性腹腔镜检查。确定了右侧的IEP。由于需要输血或子宫切除术的出血风险很高，并且她希望保持生育能力，她接受了MTX的医疗管理。的确,研究表明，女性成功地管理了预期获得更好的生殖结果，以最短的时间实现随后的宫内妊娠。此案提醒人们注意与在电视USS上识别IEP相关的挑战。为了预防孕产妇发病率和死亡率，需要高度的临床怀疑指数。
