更好的预测异位妊娠
How Best to Predict Ectopic Pregnancy
How Best to Predict Ectopic Pregnancy
Clinical judgment plus serial human chorionic gonadotropin measurements are critical for avoiding errors of diagnosis.
To diagnose ectopic pregnancy (EP), clinicians typically rely on interpretation of serial values of human chorionic gonadotropin (hCG) along with transvaginal ultrasound and clinical history (JW Emerg Med Dec 16 2011). Now, researchers have evaluated the accuracy of serial hCG measurements in predicting outcomes in 1005 women who presented at three U.S. sites with first-trimester pain or bleeding suggestive of pregnancies of unknown location.
Patients were followed until they were diagnosed with EP (179 pregnancies), miscarriage (567), or intrauterine pregnancy (IUP; 259). Misclassification of an IUP was best avoided by using 35% as the minimum expected hCG increase over 2 days. That same cutoff, when applied in combination with a minimum expected 2-day hCG decrease of 36% to 47% (depending on the initial level), provided the optimal balance of sensitivity and specificity for predicting an EP. However, sole use of serial hCG measurements misclassified 16.8% of EPs and 7.7% of IUPs.
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