不明位置妊娠的研究进展

doi:10.12114/j.issn.1007-9572.2021.02.010

中国全科医学 ›› 2022, Vol. 25 ›› Issue (06): 766-770.DOI: 10.12114/j.issn.1007-9572.2021.02.010

• 新进展 • 上一篇

不明位置妊娠的研究进展

时娟娟1, 崔秀娟1, 张丹2, 蔺莉3,^*

1．277599　山东省滕州市，济宁医学院附属滕州市中心人民医院妇一科
2．277599　山东省滕州市，济宁医学院附属滕州市中心人民医院中药房
3．102206　北京市，北京大学国际医院妇产科

收稿日期:2021-03-21 修回日期:2021-05-20 出版日期:2022-02-20 发布日期:2022-01-25
通讯作者: 蔺莉
基金资助:
2020年山东省中医药科技项目(2020Q086);2017年济宁医学院教师科研扶持基金(JY2017FS040)

Latest Research on Pregnancy of Unknown Location

SHI Juanjuan1，CUI Xiujuan1，ZHANG Dan2，LIN Li3*

1.No.1 Gynecology Department，Tengzhou Central People's Hospital Affiliated to Jining Medical University，Tengzhou 277599，China
2.TCM Pharmacy，Tengzhou Central People's Hospital Affiliated to Jining Medical University，Tengzhou 277599，China
3.Department of Obstetrics and Gynecology，Peking University International Hospital，Beijing 102206，China
*Corresponding author：LIN Li，Professor，Chief physician；E-mail：linli488@aliyun.com

Received:2021-03-21 Revised:2021-05-20 Published:2022-02-20 Online:2022-01-25

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摘要/Abstract

摘要： 不明位置妊娠（PUL）是一个描述性术语，虽然多数PUL随后被诊断为自然流产或可存活的宫内妊娠，但仍有7%~20%发生异位妊娠。由于异位妊娠相关发病率和死亡率的潜在风险，提示临床需警惕PUL评估和治疗的相关问题。本文将从PUL的分类、随访相关工具以及治疗方法进行综述，旨在为临床医生提供更多参考。

关键词: 妊娠, 异位, 不明位置妊娠, 妊娠, 孕酮, 绒毛膜促性腺激素, 流产, 随访, 治疗

Abstract:

Pregnancy of unknown location (PUL) is a descriptive term, and while most cases of PUL are subsequently diagnosed with a spontaneous abortion or viable intrauterine pregnancy, 7% to 20% develop to ectopic pregnancy. The potential risk of ectopic pregnancy-related morbidity and mortality suggests that clinical attention should be paid to PUL assessment and treatment. We reviewed the latest research on PUL, including its classification, follow-up tools and treatment-related issues, in order to provide more references for clinicians.

Key words: Pregnancy, ectopic, Pregnancy of unknown location, Pregnancy, Progesterone, Chorionic gonadotropin, Abortion, Follow-up, Treatment

中图分类号:

R714.22

时娟娟,崔秀娟,张丹,等. 不明位置妊娠的研究进展[J]. 中国全科医学, 2022, 25(06): 766-770. DOI: 10.12114/j.issn.1007-9572.2021.02.010.

SHI Juanjuan, CUI Xiujuan, ZHANG Dan, LIN Li.

Latest Research on Pregnancy of Unknown Location [J]. Chinese General Practice, 2022, 25(06): 766-770.

参考文献 41

[1]	CARUSI D. Pregnancy of unknown location：Evaluation and management[J]. Semin Perinatol，2019，43(2)：95-100. DOI：10.1053/j.semperi.2018.12.006.
[2]	RUBAL L, CHUNG K. Do you need to definitively diagnose the location of a pregnancy of unknown location? The case for "yes" [J]. Fertil Steril，2012，98(5)：1078-1084. DOI：10.1016/j.fertnstert.2012.09.033.
[3]	CONDOUS G, TIMMERMAN D, GOLDSTEIN S，et al. Pregnancies of unknown location：consensus statement[J]. Ultrasound Obstet Gynecol，2006，28(2)：121-122. DOI：10.1002/uog.2838.
[4]	BARNHART K, VAN MELLO N M, BOURNE T，et al. Pregnancy of unknown location：a consensus statement of nomenclature，definitions，and outcome[J]. Fertil Steril，2011，95(3)：857-866. DOI：10.1016/j.fertnstert.2010.09.006.
[5]	KOLTE A M, BERNARDI L A, CHRISTIANSEN O B，et al. Terminology for pregnancy loss prior to viability：a consensus statement from the ESHRE early pregnancy special interest group[J]. Hum Reprod，2015，30(3)：495-498. DOI：10.1093/humrep/deu299.
[6]	FIELDS L, HATHAWAY A. Key concepts in pregnancy of unknown location：identifying ectopic pregnancy and providing patient-centered care[J]. J Midwifery Womens Health，2017，62(2)：172-179. DOI：10.1111/jmwh.12526.
[7]	KIRK E, BOTTOMLEY C, BOURNE T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location[J]. Hum Reprod Update，2014，20(2)：250-261. DOI：10.1093/humupd/dmt047.
[8]	SCHUNEMAN M, VON WALD T, HANSEN K. Pregnancy of unknown location[J]. S D Med，2015，68(4)：163-167.
[9]	HUCHON C, DEFFIEUX X, BEUCHER G，et al. Pregnancy loss：French clinical practice guidelines[J]. Eur J Obstet Gynecol Reprod Biol，2016，201：18-26. DOI：10.1016/j.ejogrb.2016.02.015.
[10]	陈国庆，乔宠. 生化妊娠病因及治疗的研究进展[J]. 中国计划生育和妇产科，2016，8(9)：16-19.
[11]	PEREIRA P P, CABAR F R, GOMEZ Ú T，et al. Pregnancy of unknown location[J]. Clinics （Sao Paulo），2019，74：e1111. DOI：10.6061/clinics/2019/e1111.
[12]	BOBDIWALA S, AL-MEMAR M, FARREN J，et al. Factors to consider in pregnancy of unknown location[J]. Women's Heal Lond Engl，2017，13(2)：27-33. DOI：10.1177/1745505717709677.
[13]	CORDINA M, SCHRAMM-GAJRAJ K, ROSS J A，et al. Introduction of a single visit protocol in the management of selected patients with pregnancy of unknown location：a prospective study[J]. BJOG：Int J Obstet Gynaecol，2011，118(6)：693-697. DOI：10.1111/j.1471-0528.2011.02893.x.
[14]	GUHA S, AYIM F, LUDLOW J，et al. Triaging pregnancies of unknown location：the performance of protocols based on single serum progesterone or repeated serum hCG levels[J]. Hum Reprod，2014，29(5)：938-945. DOI：10.1093/humrep/deu045.
[15]	CONNOLLY A, RYAN D H, STUEBE A M，et al. Reevaluation of discriminatory and threshold levels for serum beta-HCG in early pregnancy[J]. Obstet Gynecol，2013，121(1)：65-70. DOI：10.1097/aog.0b013e318278f421.
[16]	DOUBILET P M, BENSON C B, BOURNE T，et al. Diagnostic criteria for nonviable pregnancy early in the first trimester[J]. N Engl J Med，2013，369(15)：1443-1451. DOI：10.1056/NEJMra1302417.
[17]	American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.193：tubal ectopic pregnancy[J]. Obstet Gynecol，2018，131(3)：e91-103. DOI：10.1097/AOG.0000000000002560.
[18]	MAUSNER GEFFEN E, SLYWOTZKY C, BENNETT G. Pitfalls and tips in the diagnosis of ectopic pregnancy[J]. Abdom Radiol：NY，2017，42(5)：1524-1542. DOI：10.1007/s00261-016-1020-4.
[19]	American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.200：early pregnancy loss[J]. Obstet Gynecol，2018，132(5)：e197-207. DOI：10.1097/AOG.0000000000002899.
[20]	BOBDIWALA S, HARVEY R, ABDALLAH Y，et al. The potential use of urinary hCG measurements in the management of pregnancies of unknown location[J]. Hum Fertil （Camb），2020：1-8. DOI：10.1080/14647273.2020.1777590.
[21]	BARNHART K, SPEICHER D W. Molecular diagnosis of ectopic pregnancy[J]. Expert Rev Mol Diagn，2011，11(8)：759-762. DOI：10.1586/erm.11.72.
[22]	SENAPATI S, BARNHART K T. Biomarkers for ectopic pregnancy and pregnancy of unknown location[J]. Fertil Steril，2013，99(4)：1107-1116. DOI：10.1016/j.fertnstert.2012.11.038.
[23]	CHETTY M, SAWYER E, DEW T，et al. The use of novel biochemical markers in predicting spontaneously resolving 'pregnancies of unknown location’[J]. Hum Reprod，2011，26(6)：1318-1323. DOI：10.1093/humrep/der064.
[24]	BOBDIWALA S, SASO S, VERBAKEL J Y，et al. Diagnostic protocols for the management of pregnancy of unknown location：a systematic review and meta-analysis[J]. BJOG，2019，126(2)：190-198. DOI：10.1111/1471-0528.15442.
[25]	CHRISTODOULOU E, BOBDIWALA S, KYRIACOU C，et al. External validation of models to predict the outcome of pregnancies of unknown location：a multicentre cohort study[J]. BJOG：Int J Obstet Gy，2021，128(3)：552-562. DOI：10.1111/1471-0528.16497.
[26]	BOBDIWALA S, CHRISTODOULOU E, FARREN J，et al. Triaging women with pregnancy of unknown location using two-step protocol including M6 model：clinical implementation study[J]. Ultrasound Obstet Gynecol，2020，55(1)：105-114. DOI：10.1002/uog.20420.
[27]	CARUSI D. Pregnancy of unknown location：Evaluation and management[J]. Semin Perinatol，2019，43(2)：95-100. DOI：10.1053/j.semperi.2018.12.006.
[28]	CALLEN P W, NORTON M E, SCOUTT L M，et al. Callen's ultrasonography in obstetrics and gynecology[M]. Sixth edition.Philadelphia：Elsevier，2017：626-703.
[29]	PONTIUS E, VIETH J T. Complications in early pregnancy[J]. Emerg Med Clin N Am，2019，37(2)：219-237. DOI：10.1016/j.emc.2019.01.004.
[30]	SCIBETTA E W, HAN C S. Ultrasound in early pregnancy：viability，unknown locations，and ectopic pregnancies[J]. Obstet Gynecol Clin North Am，2019，46(4)：783-795. DOI：10.1016/j.ogc.2019.07.013.
[31]	FADEN M S, KHAYAT S, BROWN R N. Pregnancy of unknown location：a survey-based evaluation of when and why physicians intervene?[J]. JOGC，2017，39(5)：335-340. DOI：10.1016/j.jogc.2017.01.007.
[32]	FLYNN A N, SCHREIBER C A, ROE A，et al. Prioritizing desiredness in pregnancy of unknown location[J]. Obstet Gynecol，2020，136(5)：1001-1005. DOI：10.1097/aog.0000000000004124.
[33]	BARNHART K T, SAMMEL M D, STEPHENSON M，et al. Optimal treatment for women with a persisting pregnancy of unknown location，a randomized controlled trial：The ACT-or-NOT trial[J]. Contemp Clin Trials，2018，73：145-151. DOI：10.1016/j.cct.2018.09.009.
[34]	BARNHART K T, GUO W S, CARY M S，et al. Differences in serum human chorionic gonadotropin rise in early pregnancy by race and value at presentation[J]. Obstet Gynecol，2016，128(3)：504-511. DOI：10.1097/AOG.0000000000001568.
[35]	BENOR A, GRAZI R, KULAK D. A case report of an abnormal trend in hCG levels in a pregnancy complicated by ovarian hyperstimulation syndrome[J]. Case Rep Women's Heal，2019，21：e00096. DOI：10.1016/j.crwh.2019.e00096.
[36]	OZYUNCU O, TANACAN A, DURU S A，et al. Methotrexate therapy for ectopic pregnancies：a tertiary center experience[J]. Rev Bras Ginecol Obstet，2018，40(11)：680-685. DOI：10.1055/s-0038-1675807.
[37]	VAN MELLO N M, MOL F, VERHOEVE H R，et al. Methotrexate or expectant management in women with an ectopic pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison[J]. Hum Reprod，2013，28(1)：60-67. DOI：10.1093/humrep/des373.
[38]	FRIDMAN D, HAWKINS E, DAR P，et al. Methotrexate administration to patients with presumed ectopic pregnancy leads to methotrexate exposure of intrauterine pregnancies[J]. J Ultrasound Med，2019，38(3)：675-684. DOI：10.1002/jum.14751.
[39]	PARKS M A, BARNHART K T, HOWARD D L. Trends in the management of nonviable pregnancies of unknown location in the United States[J]. Gynecol Obstet Invest，2018，83(6)：552-557. DOI：10.1159/000488760.
[40]	INSOGNA I G, FARLAND L V, MISSMER S A，et al. Outpatient endometrial aspiration：an alternative to methotrexate for pregnancy of unknown location[J]. Am J Obstet Gynecol，2017，217(2)：185.e1-185.e9. DOI：10.1016/j.ajog.2017.04.023.
[41]	PARKS M A, BARNHART K T, HOWARD D L. Trends in the management of nonviable pregnancies of unknown location in the United States[J]. Gynecol Obstet Invest，2018，83(6)：552-557. DOI：10.1159/000488760.

不明位置妊娠的研究进展

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