| An ectopic pregnancy refers to a pregnancy implanted outside of the uterine cavity with over98%implanting in the Fallopian tube.Ectopic pregnancy(EP) continues to be a significant cause of maternal morbidity and mortiality in more than6%of pregnant women.The correct primary diagnosis of ectopic pregnancy will be helpful in reducing mortality and improving subsequent normal pregnancy rate.It is still a worldwide comment as to make sure a pregnancy of unknown location(PUL) will be helpful to diagnose a ectopic pregnancy, adopt a more appropriate intervention for patients. We practiced a retrospective clinical study of ectopic pregnancy which were admitted to Gynecology and Obstetrics Hospital of FuDan University from2011to July,2012.We aim to summarize the clinical features fo thePULs,the indication for conservative treatment of ectopic pregnancy in our hospital,and the efficacy evaluation after surgical intervention of a tubal ectopic pregnancy.Subjects and methods:A retrospective clinical study of EP was performed including all the patients,who were suspected as EP, admitted to Gynecology and Obstetrics Hospital of FuDan University from January,2011to July,2012. A postoperative follow-up questionnaire was used to investigate the information including menstrual change and the reproductive outcome after EP among all the patients by telephone. ROC curve analysis, chi-square test, t-test, univariate analysis, and multivariate analysis were performed for data analysis.Results:The overall patients admitted to our hospital in the past1.5years are3377cases.There were tubal pregnancy which accounted54.75%of all EP cases.160cases were caesarean scar pregnancy;66cases were uterine cornu pregnancy;16cases were ovary pregnancy;20cases were cervical pregnancy;4cases were abdominal pregnancy and2cases were omental pregnancy;and2cases were sacral ligament pregnancy.369cases confirmed by follow-up transvagianl ultrasound were intrauterine pregnancy,147cases were spontaneous abortion.The tubal pregnancy incidence is still leading a upword trend in last1.5years, despite the relative percentage was lower.As the statistic recorded that in1995,there were282cases of tubal pregnancy, rose to771cases in2005, then rose to1849cases in July2012. In recent years,the caesarean scar pregnancy increased significantly,while published data showed a total number of143caesarean scar pregnancy during1995-2010, and our data accumulated160cases.The typical clinical manifestation of EP are menopause,blooding,abdominal pain and a combination of blooding and abdominal pain which accounts respectively34.28%,68.13%,12.76%and80.48%,showing that the EP patients mostly represented irregular vaginal bleeding or the symptoms of vaginal bleeding with abdominal pain.The average of serum β-hCG of suspected EP patients at0hours(0h β-hCG) was2806.32±5539mIU/mLmIU/mL.Among all the EP patients,the serum β-hCG detected in dayO below2000mIU/mL accounts64.46%,while serum β-hCG more than10000mIU/mL accounts only9.84%.The average of serum β-hCG at48hours(48hβ-hCG) was3414.66±6877.84mIU/mL,and the average β-hCG ratio (β-hCG at48hours/β-hCG at0hours) was1.17±0.68,under the ROC curve of p-hCG ratio,the β-hCG ratio<1.25resulted in a sensitivity and specificity of91.2%,89.5%respectively.There were1438(97.6%) cases taking ultrasound examination of these all EP patients.And1419cases were found adnexal mass,as there were271(19.1%) cases’s mass diameter>3cm,1148(80.9%) cases’s mass diameter<3cm, another137(9.7%) cases were detected gestational sac or with yolk sac.As patients attending early pregnancy units suspected as EP in the diagnostic evaluation of PUL,there were usually three main treatments including expectant,medical,and surgical approaches. Of all the remain stable patients,504cases were treated with conservative treatment,such as expenctant management, administer MTX or mifepristone,and there were494(98.2%) cases successfully treated.The average of Oh β β-hCG among these patients was314.08mIU/mL,and the48h ββ-hCG was197.49mIU/mL.There were1849patients were treated with surgry.975patients were taken laparoscopic salpingostomy.862cases were practiced with laparoscopic salpingectomy.While there was only14patients were proceeded with laparotomy(9cases for salpingostomy,5cases for salpingectomy).Our hospital’s drug therapy, including①MTX150mg intravenously (single use, week interval period)②The MTX20mg intramuscular injection (once a day, five days a week interval cycle or every other day),③MTX intravenously or muscle injection method combined with mifepristone therapy. Which the program applies to serum β-hCG values less than1500mIU/mL in patients with a cure rate of84.38%; program mainly used in serum β-hCG values less than1000mIU/mL in patients, the cure rate of up to86.07%; program four major pairs serum β-hCG value is less than150mIU/mL in patients with a high cure rate; program five mainly applied to the serum β-hCG values less than1000mIU/mL in patients, the cure rate was94.4%Our hospital for treatment of ectopic pregnancy to select the appropriate treatment indications:48h0-hCG/Oh β-hCG ratio<0.86, with a higher success rate of conservative treatment, combined with the B-ultrasound ectopic pregnancy mass the size of less than15mm,pelvic fluid less than14mm high success rate with conservative treatment, drug treatment may be used when the the0.86<48h β-hCG/Oh β-hCG ratio<0.97, and higher success rate.Our group included a total treatment of choice because of tubal pregnancy tubal incision Embryo surgery or salpingectomy and complete information case a total of1157cases, follow-up the HSG results or reproductive hormone results in929cases,228cases were lost to follow because phone Error/vacancies, the patient refused to cooperate with.480cases of tubal pregnancy incision embryo the HSG examination cases postoperative to our hospital follow-up line, a total of341cases of pregnancy outcome occurs, pregnancy outcomes, including normal intrauterine pregnancy, intrauterine pregnancy, spontaneous abortion and intrauterine pregnancy abortion. The group new tubal rating system tubal pregnancy incision bilateral tubal status embryo intraoperative and postoperative hysterosalpingography check ratings and rated lower side of the advantages of the fallopian tubes, the analysis of the degree of tubal score with intrauterine pregnancy. The follow-up results suggest that after3months,16cases of intrauterine pregnancy,4-6months after127cases of intrauterine pregnancy, after the July-September were120cases of intrauterine pregnancy, after10December53cases of intrauterine pregnancy, after13-15months,25cases of intrauterine pregnancy, after more than18months, two cases of intrauterine pregnancy follow-up to the degree of tubal rating intrauterine pregnancy, found that the degree of tubal rated as mild (≤7points), within15months after intrauterine pregnancy rate averaged50%, when the degree of tubal rated moderate (8-15points),15months after surgery Palace within the average pregnancy rate reached about40%, especially after September intrauterine pregnancy rate, when the degree of tubal rated severe (16-48points), intrauterine pregnancy rate in the15months after an average of only15%, indicating closely related to the intrauterine pregnancy outcome within15 months after tubal functional status, tubal rated as mild, it is recommended per pregnancy test within15months after surgery, tubal rating of moderate, positive pregnancy test is recommended after9months, and when the tubal ratings severe, patients should not test for pregnancy, intrauterine pregnancy rate is low, may recommend in vitro fertilization-embryo transfer in assisted reproduction.Ovarian blood supply in part from the tubal ovarian mesangial tubal pregnancy tubal resection may cause ovarian blood supply is affected, thereby undermining the function of the ovarian secretion of sex hormones in this group were followed up salpingectomy and tubal tubal pregnancy line cut embryowithin one year of surgery postoperative reproductive endocrine hormone changes, a total of449cases of postoperative follow-up to the the reproductive endocrine six hormones measured cure cases of tubal pregnancy. After1-3months,4-6months after surgery, after7-9months for the sector, followed up for different time basic reproductive endocrine hormone changes, follow-up to1-3months after row of Reproductive Endocrinology check121patients, age between the two groups was no significant difference (P=0.948), more reproductive hormone follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2) and progesterone (P) androgen (T) the five hormones between the two groups were not statistically different (P values were greater than0.05), prolactin (PRL) difference between the groups was statistically significant (P=0.026), the mean PRL hormone tubal cut the embryo group than in the tubal resection group was slightly higher, and PRL hormone values are based on hormones within the normal range.4-6months after the Reproductive Endocrinology check247cases, no significant difference of age between the two groups (P=0.215), more reproductive endocrine hormones FSH, LH, P, T four hormones between the two groups no significant difference respectively (P>0.05); PRL hormone group difference was statistically significant (P=0.005), E2hormone group difference was statistically significant (P=0.008) between the mean of the two hormones showed tubal incision the embryo group than tubal resection group was slightly higher, but the two hormones values are based on hormones within the normal range.7-9months after row reproductive endocrine examination75cases, age between the two groups was no significant difference (P=0.046), reproductive hormone six hormones between the two groups were not statistically different (P values were greater than0.05). This group of patients were divided into two age groups,20-30years old,31-40years old, using logistic regression analysis showed that different ages and reproductive endocrine changes in hormone concentrations no significant correlation.Conclusions:The unknown location ectopic pregnancy is suspected ectopic pregnancy status, which means urine test or blood test positive pregnancy test, but can not be diagnosed in the ultrasound.48h β-hCG/Oh β-hCG ratio threshold of1.25for the diagnostic cut-off point to helpdiagnostic window of ectopic pregnancy, the sensitivity was91.2%, specificity of89.5%. Indications of our hospital with conservative treatment (including the conservative observation look forward to therapy, medication)48h0-hCG/Oh β-hCG ratio<0.86, combined with the B-ultrasound suspicious ectopic pregnancy mass size is less than15mm, pelvic fluid less than14mm, a higher success rate with conservative treatment, drug treatment may be used when the the0.86<48h β-HCG/Oh β-HCG ratio<0.97, and higher success rate. Tubal incision Embryo surgery again within9months after intrauterine pregnancy outcome the tubal function score of less than7points can test pregnant after12months, less than15points after9months may be triedpregnant, but higher than the16points is recommended to undergo in vitro fertilization-embryo transfer in assisted reproductive; salpingectomy had no significant effect on ovarian secretion of sex hormones function, within one year of follow-up ovarian secretion of sex hormone levels remain normal, and the20-40year age group will not affect the reproductive hormone concentration. |
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