异位妊娠是妊娠头三个月发病和死亡的重要原因。需要特定的β-人绒毛膜促性腺激素(β-hCG)水平才能符合诊断测试(盆腔超声)的医院协议可能会延迟诊断和治疗。在这项研究中,我们试图确定β-hCG水平与异位妊娠大小之间的关系以及相关结局。
■我们在一个城市,专门从事产科护理的学术急诊科,从2015年1月1日-2017年12月31日。提取的变量包括演示文稿,治疗,不良结果,和破裂率。
■我们确定了519例独特的异位妊娠。在那些宫外孕中,22.9%的人在超声波上有破裂的证据,14.4%的患者在就诊时表现出血流动力学不稳定的证据(脉搏>100次/分钟;收缩压<90mmHg;或明显失血的证据)。医疗管理结果如下:177例接受单剂量甲氨蝶呤的患者,14.7%的医疗管理失败,需要手术干预;在接受多剂量甲氨蝶呤的46人中,36.9%的医疗管理失败,需要手术干预。最终,55.7%的患者需要对其异位妊娠进行手术治疗。初始表现时的平均β-hCG水平为每毫升7,096毫国际单位(mIU/mL)(SD88,872mIU/mL),中位数为1,289mIU/mL;50.4%的异位妊娠患者的β-hCG水平低于1,500mIU/mL的标准歧视区。此外,有破裂证据的患者中有44%的β-hCG水平低于1,500mIU/mL。异位妊娠的大小(基于最大尺寸,以毫米为单位)与β-hCG水平的比较显示出非常弱的相关性(r=0.144,P<.001),超声检测异位妊娠与β-hCG水平无关。
■β-hCG水平与异位妊娠的存在或大小无关。在临床怀疑异位妊娠的患者中,无论β-hCG水平如何,都需要进行诊断性影像学检查。几乎六分之一的患者有血流动力学不稳定的证据,大约四分之一的患者出现破裂的证据,需要紧急手术治疗。最终,超过一半的患者需要手术程序来明确治疗异位妊娠.
UNASSIGNED: Ectopic pregnancies are a significant cause of morbidity and mortality in the first trimester of pregnancy. Hospital protocols requiring a specific beta-human chorionic gonadotropin (β-hCG) level to qualify for diagnostic testing (pelvic ultrasound) can delay diagnosis and treatment. In this study we sought to determine the relationship between β-hCG level and the size of ectopic pregnancy with associated outcomes.
UNASSIGNED: We performed a retrospective case review of patients diagnosed with ectopic pregnancy in an urban, academic emergency department specializing in obstetrical care, from January 1, 2015-December 31, 2017. Variables extracted included presentation, treatment, adverse outcomes, and rates of rupture.
UNASSIGNED: We identified 519 unique ectopic pregnancies. Of those ectopic pregnancies, 22.9% presented with evidence of rupture on ultrasound, and 14.4% showed evidence of hemodynamic instability (pulse >100 beats per minute; systolic blood pressure <90 millimeters of mercury; or evidence of significant blood loss) on presentation. Medical management outcomes were as follows: of 177 patients who received single-dose methotrexate, 14.7% failed medical management and required surgical intervention; of 46 who received multi-dose methotrexate, 36.9% failed medical management and required surgical intervention. Ultimately, 55.7% of patients required operative management of their ectopic pregnancy. Mean β-hCG level at initial presentation was 7,096 milli-international units per milliliter (mIU/mL) (SD 88,872 mIU/mL) with a median of 1,289 mIU/mL; 50.4% of ectopic pregnancies presented with β-hCG levels less than the standard discriminatory zone of 1,500 mIU/mL. Additionally, 44% of the patients who presented with evidence of rupture had β-hCG levels less than 1,500 mIU/mL. Comparison of size of ectopic pregnancy (based on maximum dimension in millimeters) to β-hCG levels revealed a very weak correlation (r = 0.144, P < .001), and detection of ectopic pregnancies by ultrasound was independent of β-hCG levels.
UNASSIGNED: Levels of β-hCG do not correlate with the presence or size of an ectopic pregnancy, indicating need for diagnostic imaging regardless of β-hCG level in patients with clinical suspicion for ectopic pregnancy. Almost one-sixth of patients presented with evidence of hemodynamic instability, and approximately one quarter of patients presented with evidence of rupture requiring emergent operative management. Ultimately, more than half of patients required an operative procedure to definitively manage their ectopic pregnancy.