异位妊娠的病因及危险因素

异位妊娠是指受精卵种植并发育在正常妊娠时宫腔部位以外的妊娠。宫外孕是指受精卵着床在子宫以外。所以异位妊娠与宫外孕是有区别的。异位妊娠比宫外孕更为确切和科学。因为宫颈、宫角妊娠、剖宫产切口瘢痕妊娠、子宫憩室、子宫壁、子宫峡部、子宫小囊等妊娠仍在子宫内妊娠，不属于宫外妊娠，所以称异位妊娠为妥，而不宜称宫外孕。     

异位妊娠危险因素的研究进展

异位妊娠是受精卵着床于子宫腔以外的部位,以输卵管妊娠最常见,是妇产科常见急腹症之一。也是导致孕早期妇女死亡的重要原因。近年来各种危险因素的增加与其发病率不断上升有着密切的关系。     

持续性异位妊娠发病相关因素分析

目前，输卵管妊娠多能在破裂前得到诊断，使得异位妊娠的保守性手术有所增加。保守性手术的危险之一是残留在输卵管的绒毛组织继续增长并引起症状，甚至导致输卵管破裂，即称为持续性异位妊娠(persistert ectopic pregnancy,PEP)。我们对580例异位妊娠患者中行保守性手术的188例患者进行观察，发生PEP 12例。现对其临床资料分析如下。     

持续性异位妊娠的诊治及预防进展

持续性异位妊娠是异位妊娠保守性手术后的并发症之一,严重损害患者身心健康并造成经济负担。其发生与血h CG值、停经天数、包块大小、手术方法及术后h CG值的监测等多种因素有关。其治疗和预防方法也多种多样,包括不予任何处理的期待治疗、以甲氨蝶呤(MTX)为主的药物保守治疗和手术治疗三种,而手术治疗的路径又可分为腹腔镜或开腹手术。目前如何掌握好手术方法,合理、适时应用药物,减轻患者痛苦和费用仍是一个难题。     

早期易误诊的宫内妊娠与异位妊娠的鉴别诊断及危险因素探讨

目的　探讨宫内妊娠与异位妊娠的鉴别诊断及异位妊娠的危险因素。方法　 1 998年 1月至 2 0 0 2年7月对 36例疑为异位妊娠的宫内妊娠患者和 72例异位妊娠患者进行分析 ,并用Logistic回归法研究异位妊娠的危险因素。结果　宫内妊娠组阴道流血、腹部压痛、宫颈举痛、附件区压痛发生率明显低于异位妊娠组 (P <0 0 1、P <0 0 5、P <0 0 1、P <0 0 1 ) ,血红蛋白高于异位妊娠组 (P <0 0 5 ) ,B超下附件包块体积小于异位妊娠组 (P <0 0 5 )。阴道流血、宫颈举痛、血 β HCG、B超下附件包块体积是异位妊娠的危险因素 ,子宫压痛不支持异位妊娠。结论　阴道流血、宫颈举痛、血 β HCG、B超下附件包块体积、子宫压痛是宫内妊娠与异位妊娠的鉴别要点。     

异位妊娠多因素Logistic回归分析

异位妊娠(ectopic pregnancy)是妇产科最常见的急腹症,占妇科急腹症的80%以上,也是最易误诊的疾病和孕早期孕产妇死亡的主要原因。目前,随着B超、血HCG和腹腔镜技术的广泛应用,异位妊娠诊断的准确度越来越高,明显降低了异位妊娠导致的严重后果和死亡率。为了尽可能地降低异位妊     

妊娠高血压综合征病因学研究进展与展望

妊娠高血压综合征 (妊高征 )是导致孕产妇和围产儿病率及死亡率升高的主要原因。近半个世纪来 ,国际国内学者 ,对妊高征的病因及发病机理、治疗及预防进行了大量的研究工作。我国妇产科学界始终瞄准着国际科技前沿 ,对妊高征的病因学和发病机理进行了深入的研究 ,并取得了可喜的进展。为妊高征的有效防治奠定了理论基础。目前 ,公认的妊高征的主要发病机理是内皮细胞激活和损伤学说。1988年 ,Rodger等发现妊高征患者血清中存在细胞毒性因子 ,可导致血管内皮激活、功能障碍和结构损伤。继而大量研究表明 ,血管内皮细胞激活导致内皮细胞合成…     

异位妊娠危险因素的研究进展

异位妊娠是受精卵着床于子宫腔以外的部位,以输卵管妊娠最常见,是妇产科常见急腹症之一,也是导致孕早期妇女死亡的重要原因.近年来各种危险因素的增加与其发病率不断上升有着密切的关系.     

辅助生殖技术中影响异位妊娠发生的相关危险因素分析

目的:探讨辅助生殖技术(assisted reproductive technology,ART)后发生异位妊娠的危险因素。方法:收集2014年1月至2016年1月在本院生殖中心行ART治疗并获得临床妊娠的8548例患者的临床资料,包括女方年龄、体质量指数(BMI)、不孕原因、异位妊娠史、冻融胚胎移植内膜准备方式、胚胎移植类型、数目和期别。采用单因素及多因素Logistic回归分析不同因素对于ART后异位妊娠发生的影响。结果:8548例患者中,异位妊娠196例,异位妊娠率为2.29%。单因素分析结果显示,异位妊娠组盆腔输卵管因素、非男方因素、既往异位妊娠史、新鲜胚胎和D3胚胎移植比例均高于非异位妊娠组(P0.05)。将以上因素纳入多因素Logistic回归分析,结果显示,盆腔输卵管因素(OR=1.524,95%CI 1.100~2.111,P=0.011)和D3胚胎移植是行ART后异位妊娠发生的独立危险因素。且移植D6胚胎要比移植D5胚胎发生异位妊娠的风险低。进一步对盆腔输卵管因素进行分层分析,表明移植D5或D6胚胎异位妊娠发生率显著降低(P0.01)。结论:盆腔输卵管因素以及D3胚胎移植可导致ART后异位妊娠发生增加。囊胚移植,尤其是D6囊胚移植有利于降低异位妊娠发生的风险。     

异位妊娠

异位妊娠是指发生于子宫以外的妊娠。其中绝大部分（98％）发生于输卵管，而卵巢、宫颈、腹腔也可发生，但较为罕见。异位妊娠占妊娠总数的1／150，发生率较20年前提高了4倍。     

异位葡萄胎的诊断与治疗--附三例病例报告

目的：探讨异位葡萄胎的诊断和治疗,方法：回顾性分析我院收治的3例异位葡萄胎患者的临床资料。结果：异位葡萄胎患者的临床表现根据异位的部位不同表现各异,异位葡萄胎早期易发生局部浸润和远处转移,数字减影血管造影术,彩色多普勒超声,腹腔镜等检查在异位葡萄胎的诊断中具有重要作用,规范的化学治疗及耐药病灶的手术切除仍为其主要治疗手段,结论：异位葡萄胎患者应强调预防性化学治疗的重要性,并重视发生转移后的及时诊断与治疗。     

Diagnosis and treatment of heterotopic pregnancy compared with ectopic pregnancy

STUDY OBJECTIVE: To compare the diagnosis and management of ectopic (EP) and heterotopic pregnancies (HP). DESIGN: Retrospective comparative study (Canadian Task Force classification II-2). SETTING: University tertiary referral center for endoscopic surgery. PATIENTS: Twelve women with HP and 210 women with laparoscopically confirmed EP. INTERVENTION: Laparoscopic treatment. MEASUREMENTS AND MAIN RESULTS: Among the 12 women with HP, all but 1 had received ovulation induction, 10 underwent in vitro fertilization-embryo transfer, and 1 conceived with clomiphen citrate. In the EP group 33 patients (15.7%) conceived spontaneously (p <0.05). Six women (50%) with HP had had previous pelvic surgery and three had a history of EP and salpingectomy. Four patients (33.4%) with HP and 29 (13.8%) with EP suffered from hypovolemic shock and required blood transfusion (p <0.05). Three of these four women with HP experienced physician and patient delays before admission. The sonographic diagnosis was correct in all women with HP and in 94.3% of women with EP. The median gestational age at diagnosis was 7.5 and 7.2 weeks for HP and EP, respectively. Six (50%) women with HP had evidence of fetal pulse in the ectopic gestation compared with 17 (8.1%) with EP (p <0.05). In addition, 66.7% and 24.7%, respectively, had ruptured tube (p <0.05). Mean +/- SD hemoperitoneum was 833.4 +/- 777 and 305 +/- 121 ml, respectively (p <0.05). Conversion to laparotomy was required in one (8.3%) and eight (3.8%) women, respectively (p <0.05). No major operative or postoperative maternal complications occurred in either group. Two women with HP had miscarriages, two have a continuing pregnancy, and eight delivered healthy newborns. CONCLUSION: Women with HP are at significantly greater risk for hypovolemic shock and requiring blood transfusion than those with EP. The diagnosis of EP in cases of HP is difficult due to the presence of an intrauterine gestational sac and hyperstimulated ovaries. A greater level of suspicion may allow early laparoscopic intervention before life-threatening intraabdominal bleeding has occurred.     

Diagnosis of ectopic pregnancy

The declining death rate from ectopic pregnancy over the last 30 years has resulted not from improvements in operative technique, anesthesia, or blood banking but primarily due to more rapid diagnosis that allows for earlier treatment. Algorithms have been developed to eliminate delays in ordering the various diagnostic tests in the appropriate order. Diagnostic tests include serum human chorionic gonadotropin and progesterone levels, culdocentesis, dilatation and curettage, transvaginal ultrasound, and laparoscopy.     

Diagnosis of ectopic pregnancy.

The diagnosis of ectopic pregnancy remains a challenge to the clinician, despite advances in sonographic and biochemical technology. Contemporary practice requires an understanding of the normal sonographic features and hormonal profiles for normal pregnancy as well as the pathogenesis of an ectopic nidation. Frequently, the diagnosis remains uncertain until laparoscopy or dilatation and curettage have been performed.     

Local treatment of ectopic pregnancy

The treatment of ectopic pregnancies has evolved from a purely surgical route with routine removal of the fallopian tube to one with multiple options. Medical treatment can be administered systemically or via local injection. Local delivery of chemotherapeutic agents is a safe and proven modality that is especially indicated for pregnancies in which a laparoscopic approach is not ideal and systemic therapy either has failed or is not desired. Local therapy has the potential to document immediately the cessation of fetal heart activity. Nontubal ectopic pregnancies may be ideally suited to local therapy, especially when there is a fetal heart present. Transvaginal ultrasound is the preferred mode for guidance and laparoscopic guidance has a limited role. Although a multitude of agents have been proposed, methotrexate, KCl, and hyperosmolar glucose are the most widely used and readily available. Local therapy has an important place in the armamentarium of the treatment of ectopic pregnancies.     

Surgical treatment of ectopic pregnancy

In most cases of ectopic pregnancy, medical treatment with methotrexate is successful. However, some cases still require surgery and laparoscopy is an effective approach. The candidates for surgical treatment include women who are not suitable to or have failed methotrexate treatment, those with heterotopic pregnancy, or those who are hemodynamically unstable. In women of reproductive age with tubal pregnancy, salpingostomy is the preferred surgical method. Conversely, salpingectomy is a better treatment for women with severely damaged fallopian tube, recurrent ectopic pregnancy in the same tube, uncontrolled bleeding after salpingostomy, large tubal pregnancy (> 5 cm), heterotopic pregnancy, and for those who have completed their family. Similar to treatment of a tubal pregnancy, cervical and interstitial pregnancy could be treated medically first. Most abdominal pregnancies are diagnosed late in pregnancy. However, when the diagnosis is made early, laparoscopic removal of the pregnancy should be performed.