异位妊娠54例临床分析

目的:分析异位妊娠的发病因素、早期诊断及治疗方法。方法:对54例异位妊娠患者的临床资料进行回顾性分析。结果:54例异位妊娠的平均发病年龄为30.6岁,多次孕产史、人工流产史、盆腔手术史及置宫内节育器是其好发因素,停经、腹痛、阴道流血是其常见症状,首诊误诊率达48.15%。54例患者中,2例保守治疗成功,52例经手术治愈。结论:根据异位妊娠的临床特点结合辅助检查,可提高早期诊断率,减少误诊,改善预后。     

异位妊娠发病相关因素及早期诊断的临床分析

目的:探讨异位妊娠的发病原因及早期诊断的方法。方法:回顾性分析2003年1月～2007年1月收治的240例异位妊娠患者,对流产史、盆腔炎史、上环史、异位妊娠史等因素及早期诊断进行分析。结果:盆腔炎、流产史、IUD应用、输卵管病理改变及手术史对异位妊娠的发生有明显的影响。超声、血β-HCG及血孕酮是早期诊断的主要方法。结论:异位妊娠的致病因素是复杂的,盆腔炎、流产史、输卵管病理改变及手术史是异位妊娠发生的危险因素,其中盆腔炎为最根本原因。结合病史、查体及相关辅助检查才能早期诊断异位妊娠,早期得到治疗。     

计划生育手术与异位妊娠相关因素的临床分析

目的:通过对我院异位妊娠患者的临床资料分析,探讨计划生育手术与其发生的相关因素的关系.方法:回顾性的总结分析我院2005年3月9日-2010年5月20日妇产科进行诊治的80例异位妊娠患者的临床病例.结果:异位妊娠的好发年龄在20岁-36岁之间,计划生育手术是异位妊娠的主要发病因素,计划生育手术后发生率较高的疾病为输卵管慢性炎症(P<0.05).结论:异住妊娠的发生因所有年龄、计划生育手术、感染等,减少或避免计划生育手术对预防异位妊娠的发生有积极的作用.     

异位妊娠发病相关因素及其与盆腔手术的关系

目的:分析异位妊娠患者临床资料,探讨其发生的相关因素及与盆腔手术(包括计划生育手术、腹部手术)的关系。方法:收集2003年1月～2007年12月我院收治的405例异位妊娠患者病历资料进行回顾性分析。结果:异位妊娠好发年龄为20～39岁,腹部手术后及计划生育手术后输卵管慢性炎症的发生率均较高(P<0.05)。结论:异位妊娠与计划生育手术、腹部手术史及感染密切相关,倡导采取安全、有效的避孕措施,降低宫腔手术率,对预防异位妊娠的发生起到积极作用。     

548例异位妊娠相关因素分析

异位妊娠是常见的一种妇产科急腹症，近年来其发病率逐渐上升．尽管异位妊娠的早期诊断和治疗有一定进展，但异位妊娠仍是导致孕早期妇女死亡的重要原因之一。为正确认识其临床特征，早期诊断治疗，改善预后，我们对我院2002年1月-2007年12月548例异位妊娠患者进行相关因素分析，现报道如下。     

妊娠早期不良结局的相关因素分析

目的:探讨与早期妊娠不良结局的相关因素,为临床处理提供依据。方法:收集2005年1月～2007年12月产科门诊以停经就诊或者以阴道出血就诊而尿妊娠试验阳性的患者资料,填写调查表,追踪妊娠结局。结果:共收集病例508例,其中早孕不良结局者122例,包括不全流产9例,完全流产22例,过期流产7例以及异位妊娠62例。阴道出血是患者就诊的主要症状,阴道出血的发生率在不良妊娠结局组显著高于对照组(P<0.05),同时,年龄>35岁,既往有自然流产史或者异位妊娠史、不良生活习惯、高体重指数不良妊娠结局组与对照组相比差异均有显著性(P<0.05),而距离前次妊娠间隔<6个月、是否意愿或者计划妊娠,以及近3个月发热病史两组比较差异无显著性。结论:与妊娠早期不良结局相关的因素包括高龄、高体重指数、不良生活习惯、不良孕产史,应早期识别危险因素,避免延误诊断和过度检查。     

异位妊娠的超声诊断价值

<正>异位妊娠是指受精卵着床于子宫以外的器官和组织,是妇产科常见的急腹症之一,其发生率占妊娠的0.5%～1%[1],并有逐年增加的趋势。本文收集了2005年1月～2007年12月我院收治的40例异位妊娠临床资料,旨在评价超声检查在异位妊娠早期诊断中的应用价值。现报告如下。     

体外受精-胚胎移植后异位妊娠16例临床分析

目的 :探讨体外受精 -胚胎移植后异位妊娠发生的高危因素、临床特点及早期诊治方法。方法 :对 2 0 0 0年 1月～ 2 0 0 3年 2月到佛山市妇幼保健院接受体外受精 -胚胎移植治疗后发生异位妊娠的 1 6例临床资料进行回顾性分析。结果 :体外受精 -胚胎移植后异位妊娠发生率为 6.1 5%。其中因输卵管病变发生异位妊娠 1 3例 (81 .2 5% ) ,非输卵管病变发生异位妊娠 3例 (1 8.75% )。年龄、移植胚胎数目与异位妊娠的发生无关。结论 :异位妊娠的发生与输卵管病变有关 ,妊娠早期测定人绒毛膜促性腺激素和行 B超检查 ,有利于异位妊娠的早期诊断和治疗     

44例异位妊娠发病相关因素分析

近年来，异位妊娠发病率成明显上升趋势，是妇产科常见的急腹症之一。若不及时诊断和积极抢救，可危及生命。因此，积极预防，早期诊断和及时治疗异位妊娠是很有必要的。异位妊娠病因复杂，发病的相关因素很多，为了提高对此病的认识，预防异位妊娠的发生，先将我院自2000年至2004年收治经手术及病理证实的44例异位妊娠发病的相关因素探讨如下：     

IVF-ET后发生异位妊娠或宫内外同时妊娠相关因素分析

目的:探讨IVF-ET治疗后发生异位妊娠的相关因素。方法:回顾性分析2006年1～10月在南方医院生殖医学中心行体外受精-胚胎移植(IVF-ET)治疗获得临床妊娠并有最终妊娠结局的203例患者的临床资料。结果:输卵管妊娠发生率为2.46%,宫内外同时妊娠的发生率为1.48%。异位妊娠及宫内外同时妊娠的8例患者均为盆腔卵管因素不孕,6例曾行腹腔镜检查及手术。与正常宫内妊娠组相比,女方年龄、基础激素水平(E2、P、LH、FSH和T)、HCG日激素水平(E2、P、LH)、促性腺激素总量、取卵日及HCG日内膜厚度、取卵数均无显著性差异(P>0.05)。异位妊娠组既往异位妊娠次数显著多于宫内妊娠组(P<0.05)。异位妊娠组优良胚胎形成率低于宫内妊娠组,但无显著性差异(P=0.064)。不同移植人员之间的异位妊娠率无显著性差异(P>0.05)。结论:对于异位妊娠高危患者可以考虑子宫中下段移植和单囊胚移植。异位妊娠的早期诊断非常重要,早期发现宫内外同时妊娠并及早手术,可以将对宫内胎儿的影响减至最低。     

3例少见异位妊娠的病例分析并文献回顾

目的:探讨少见异位妊娠发病相关因素、临床表现、鉴别及治疗方式。方法:回顾分析中日友好医院妇科收治的3例少见异位妊娠患者的病史、辅助检查及诊疗经过并文献复习。结果:各例术前均行手术探查,术中所见及术后病理确诊为少见异位妊娠,治疗后随访血绒毛膜促性腺激素均降至正常范围。结论:临床上对于急诊育龄期妇女均需警惕异位妊娠可能,尽早诊治,减少并发症的出现。     

体外受精-胚胎移植后异位妊娠20例临床分析

目的:探讨体外受精-胚胎移植后异位妊娠的发生率、高危因素及处理方式。方法:回顾性分析2009年2月～2011年2月接受IVF/ICSI治疗后发生异位妊娠的患者20例,并随机选取IVF/ICSI治疗后正常宫内妊娠100例作为正常对照。结果:IVF/ICSI共治疗1 434个周期,临床妊娠645例,临床妊娠率为44.98%(645/1 434),其中发生异位妊娠20例,发生率为3.10%(20/645),其中宫内外同时妊娠2例,输卵管间质部妊娠2例,宫角妊娠1例。20例异位妊娠的不孕原因中,有16例为输卵管因素,3例为多囊卵巢综合征,3例有子宫内膜息肉,4例为子宫内膜异位症,8例有既往异位妊娠史,7例有流产史。两组患者的年龄、不孕年限、不孕类型、体重指数(BMI)、助孕方式、移植胚胎类型、人绒毛膜促性腺激素注射日雌二醇及黄体生成素水平、子宫内膜厚度等比较差异均无统计学意义(P>0.05),而人绒毛膜促性腺激素注射日孕激素水平、雌二醇/孕激素比值的差异有统计学意义(P<0.05)。结论:输卵管病变和盆腔炎是辅助生殖术后异位妊娠发生的高危因素,阴道超声检查结合血β-HCG值测定是最有效的诊断措施,腹腔镜下输卵管切除术是目前治疗异位妊娠的较好方法。     

Risk of ectopic pregnancy and previous induced abortion.

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.     

Ectopic pregnancy

This discussion of ectopic pregnancy covers mortality, definition, etiology, diagnosis and management, and contraception. In the 1979-81 "Report on Confidential Enquiries into Maternal Deaths in England and Wales," ectopic pregnancy accounted for 11.4% of all maternal deaths. Avoidable factors were found in 64% of deaths from ectopic pregnancy, the most common being delay in diagnosis and operative intervention. Ectopic pregnancy is the implantation of the conceptus outside the uterus or in an abnormal location within the uterus. Tubal gestation invariably has a multifactorial etiology and occurs owing to delay in the transport of the fertilized ovum. Table 1 lists causes. Salpingitis is the main cause of tubal pregnancy and now is considered to be due primarily to chlamydia. The consequences of tubal surgery, for whatever reason, and hormonal treatment also are major etiological factors. Every woman of reproductive age, especially if she has 1 or more etiological factors in her past history, who presents with a history of a missed period and irregular vaginal bleeding or abdominal pain, must be considered to have an ectopic pregnancy until proved otherwise. Diagnosis still is essentially a clinical one. In difficult cases use should be made of radioimmunoassay of beta hCG, ultrasonic scanning, and laparoscopy. In 25% of cases, a correct diagnosis was made only at laparotomy. Culdocentesis and endometrial biopsy are of limited use. In cases of ruptured ectopic pregnancy with circulatory collapse, immediate operative intervention is essential. In regard to contraception, the combined oral contraceptive (OC), in suppressing ovulation and thickening the cervical mucus, has a protective effect. Method failure does not increase the incidence of extrauterline pregnancy above normal. The progestagen-only pill is associated with a small increase in the risk of an initial and recurrent ectopic pregnancy. It does not suppress ovulation and may affect tubal motility, but it can be considered if the combined OC is contraindicated, as it is more advisable than an IUD if ectopic pregnancy is feared. Barrier methods will not affect the incidence of ectopic pregnancy and may protect against pelvic infection. It is still being debated whether the absolute incidence of ectopic pregnancy in IUD users is increased. A woman has a 0.3-5% risk of having a 1st ectopic pregnancy and a 15% chance of having a recurrence when given postcoital contraception. As with barrier methods, there is no effect on the incidence of extrauterine pregnancy with periodic abstinence, but in the case of periodic abstinence there is no protective effect against pelvic infection. Female sterilization does not protect against ectopic pregnancy. Of all failed sterilizations, 12% result in an ectopic pregnancy.     

Surveillance in a Time of Changing Health Care Practices: Estimating Ectopic Pregnancy Incidence in the United States

Objectives: Ectopic pregnancy is a common condition with significant health consequences; complications are a major cause of maternal mortality in the United States. Accurate ascertainment of the number of ectopic pregnancies occurring in the United States has been dramatically affected by changing medical practices, causing estimates based on hospital data to be falsely low. This study was performed to identify nationally representative data on ectopic pregnancies and determine overlap of these data, to calculate the annual weighted number of ectopic pregnancies and confidence intervals for these estimates, and to determine barriers to estimation of ectopic pregnancy incidence. Methods: To assess whether a national estimate of the incidence of ectopic pregnancy could be calculated, we analyzed 1992–99 data from the six nationally representative data sets that include information on ectopic pregnancy. We examined relevant data in each data set and assessed whether any combination of data sets could be used to estimate ectopic pregnancy incidence. We calculated weighted estimates and 95% confidence intervals for hospitalizations, outpatient surgeries, outpatient medical procedures, and physician visits for and self-reports of ectopic pregnancy. Results: Small sample sizes severely limited calculation of estimates of ectopic pregnancy. Data needed for assessing multiple counting was not available consistently. The likelihood of multiple counting of cases was substantial when data set counts were combined. Conclusions: A reliable incidence rate for ectopic pregnancy in the United States could not be estimated from existing nationally representative data sources. Major advances in diagnosis and treatment of ectopic pregnancy have affected surveillance in two ways: inpatient hospital treatment of ectopic pregnancy has decreased, and multiple health care visits for a single ectopic pregnancy have increased. Alternate means of surveillance are needed to improve understanding of risk factors and trends for ectopic pregnancy, and we recommend examination of the databases of public and private insurance systems and managed care systems. Similar alternate means of surveillance may be needed for other health conditions with comparable changes in management of care.     

体外受精—胚胎移植术后异位妊娠29例临床分析

目的 :探讨体外受精 -胚胎移植后异位妊娠的发生率及高危因素。方法 :对我院 1998年 9月～ 2 0 0 3年 3月接受体外受精 -胚胎移植后发生的异位妊娠 2 9例进行回顾性分析。结果 :异位妊娠发生率为 5 .8%。 2 9例异位妊娠中有 19例术前存在输卵管病变。结论 :体外受精 -胚胎移植术后发生异位妊娠的高危因素是输卵管病变、继发性不孕 ,年龄、子宫位置、移植术过程的困难程度等亦与之有关     

Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control,population-based study in France

This case-control study was associated with a regional register of ectopic pregnancy between 1993 and 2000 in France. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was powerful enough to investigate all ectopic pregnancy risk factors. The main risk factors were infectious history (adjusted attributable risk = 0.33; adjusted odds ratio for previous pelvic infectious disease = 3.4, 95% percent confidence interval (CI): 2.4, 5.0) and smoking (adjusted attributable risk = 0.35; adjusted odds ratio = 3.9, 95% CI: 2.6, 5.9 for >20 cigarettes/day vs. women who had never smoked). The other risk factors were age (associated per se with a risk of ectopic pregnancy), prior spontaneous abortions, history of infertility, and previous use of an intrauterine device. Prior medical induced abortion was associated with a risk of ectopic pregnancy (adjusted odds ratio = 2.8, 95% CI: 1.1, 7.2); no such association was observed for surgical abortion (adjusted odds ratio = 1.1, 95% CI: 0.8, 1.6). The total attributable risk of all the factors investigated was 0.76. As close associations were found between ectopic pregnancy and infertility and between ectopic pregnancy and spontaneous abortion, further research into ectopic pregnancy should focus on risk factors common to these conditions. In terms of public health, increasing awareness of the effects of smoking may be useful for ectopic pregnancy prevention.     

持续性异位妊娠13例分析

目的: 探讨妇科异位妊娠术后持续性异位妊娠发生的原因、高危因素、诊断、治疗及预防措施。方法: 回顾性分析 13例持续性异位妊娠的临床特点、诊断、治疗的方法。结果: 发生持续性异位妊娠的高危因素是停经天数、β-HCG水平、手术方式等, 其中以保留患侧输卵管最为关键, 动态观察血β-HCG水平, 可早期发现持续性异位妊娠, 腹腔镜手术是治疗持续性异位妊娠的有效方法。结论: 对于具有持续性异位妊娠高危因素的异位妊娠患者, 术后应加强血β-HCG水平的监测, 对有症状PEP, 建议及早手术治疗。     

1215例异位妊娠临床症状、治疗方法的现况调查

目的:了解深圳市异位妊娠的发生情况。方法:以2005年10月~2006年9月在深圳市22家医院确诊的宫外孕患者1215例为研究对象,对其生殖道感染史、人流史、避孕史、临床症状及治疗方法进行现况调查,同时对其中进行保守治疗的155例患者和238例早期终止妊娠者进行宫颈分泌物、沙眼衣原体、解脲支原体、人型支原体培养及淋球菌、加特纳杆菌培养检测比较。结果:异位妊娠与正常妊娠之比为1∶16,与人工流产之比为1∶31,总比为1∶47.8。82.38%的异位妊娠发生在20~35岁,且主要发生在流动人口、文化程度低和无正常职业、从事服务业的人群。病例组中曾患盆腔炎、输卵管炎者及宫颈微生物衣原体、解脲、人型支原体阳性率及淋球菌、加特纳菌感染率均高于对照组,经检验差异有统计学意义(P<0.05)。异位妊娠的临床症状以停经、腹痛、阴道出血为主,发生部位以输卵管(93.17%)为主,手术治疗占86.01%。结论:流动人口、文化程度低、无正常职业、从事服务业的人群及生殖道微生物感染为异位妊娠的高危因素。加强孕前检查、普及性卫生教育、积极防治生殖道感染将有利于降低异位妊娠的发生。     

异位妊娠相关发病因素的分析

目的:通过对异位妊娠发病因素进行分析,为控制疾病的发生,降低发病率提供理论依据。方法:采用回顾性病例对照研究,以该院2000年4月1日~2003年11月30日共446例异位妊娠患者为研究组,随机抽取同期足月分娩产妇446例为对照组,对末次妊娠史、盆腔炎史、IUD应用及应用史、输卵管手术史、子宫内膜异位症、异位妊娠史、子宫肌瘤等因素进行分析。结果:盆腔炎、流产史、IUD应用及应用史、输卵管手术史对异位妊娠的发生有明显的影响。结论:盆腔炎、流产史、IUD应用及应用史、输卵管手术史是异位妊娠发病的危险因素,其中盆腔炎为最根本原因。