Ectopic Pregnancy 异位妊娠

分类:医学文献 49 0

Prevalence of ectopic pregnancy is increasing with widening use of ART and better diagnosis due to ongoing improvements in ultrasound technology. In spite of this, the latest mortality rate was the lowest registered since 1988, with 1.65/10000 deaths between 2006 and 2008 (1). Women undergoing fertility treatment often have uterine or tubal pathology and possibly a history of previous ectopic pregnancy or tubal surgery, which are all considered risk factors for extra uterine implantation. The incidence of ectopic pregnancy in assisted conception is higher than when compared to the general population, ranging from 2% to 11% (2,3). It is difficult to determine whether this increase is due to treatment or the cause of infertility itself. Furthermore, these patients are at particular risk of simultaneous occurrence of pregnancies on two or more implantation sites, with an incidence of 1/100 (4).


The difficulty with heterotopic pregnancy is that there usually is an intrauterine pregnancy, which gives false reassurance when initially identified on the scan, and diagnosis is usually late. As a result, a thorough ultrasound assessment is essential, not only to exclude extrauterine implantation, but also to identify ectopics early, so as to improve outcome and consequent fertility.


Transvaginal ultrasound is the gold standard for diagnosis of ectopic pregnancy and offers sensitivity of 87% and specificity of 94% (5). Suspicion should arise if the uterine cavity appears empty. In 15% of cases of ectopic pregnancy, a pseudogestational sac may be present, which should not be misdiagnosed as an early intrauterine pregnancy. It is important to ensure that the entire uterine cavity has been assessed, including the cervical canal and interstitial portion of the tubes. For patients with a previous Cesarean section, the uterine scar should always be reviewed. Diagnosis of ectopic pregnancy should only be made if a gestational sac or RPOC are visualized outside the uterine cavity


Reference 数据参考:

1. Wilkinson H, Trustees and Medical Advisers. Saving Mother’s Lives: reviewing maternal deaths to make motherhood safer: 2006-2008. BJOG 2011; 118:1402-1403

2. Mg e, Yeung W, So W, Ho P. An analysis of ectopic pregnancies following IVF treatment in a 10-year period. J Obstet Gynaecol 1998; 18: 359-365

3. Dubuisson J, Aubriot F, Mathieu L, et al. Rish factors for ectopic pregnancy in 556 pregnancies after IVF: implications for preventive management. Fertil Steril 1991; 56:686-690

4. Tal J, Haddad, S, Gordon N, Timor-Tritsch I. Heterotopic pregnancies after ovulation induction and ART: a literature review from 1971 to 1993. Fertil Steril 1996; 66:1-12

5. Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I, Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertil Steril 1998;69:62-65