小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 妊娠早期
- 停经
- 阴道出血
- 子宫反常地大于孕龄
其他诊断因素
- 头痛和畏光
- 呼吸短促和呼吸窘迫
- 剧烈恶心和呕吐
- 心动过速、震颤、失眠和腹泻
- 高血压
- 苍白
- 盆腔疼痛
- 子宫出血
- 外周水肿
危险因素
- 妊娠年龄的两极端
- 既往妊娠滋养细胞疾病 (GTD)
- A、B、AB 型血
- 吸烟
- 膳食脂肪和胡萝卜素减少
诊断性检查
首要检查
- 血清 β-人绒毛膜促性腺激素 (hCG)
- 全血细胞计数 (FBC
- 血清 PT、PTT
- 血清代谢检查组合
- 血清促甲状腺激素 (TSH)
- 血型及抗体筛查
- 盆腔超声检查
- 胸部 X 线检查 (CXR)
- 胎盘组织的组织学检查
治疗流程
单胎葡萄胎妊娠：希望保留生育能力
单胎葡萄胎妊娠：不希望保留生育能力
可存活的双胎：不希望择期终止妊娠
可存活的双胎：选择性终止妊娠
初步处理后：不太可能完成随访且具有妊娠滋养细胞肿瘤的高风险
撰稿人
作者
John Soper, MD
Professor
Department of Obstetrics and Gynecology
University of North Carolina
Chapel Hill
NC
利益声明
JS is an author of references cited in this topic.
Emma Rossi, MD
Assistant Professor
Department of Obstetrics and Gynecology
University of North Carolina
Chapel Hill
NC
利益声明
ER declares that she has no competing interests.
同行评议者
Jane Stewart, PhD, MSc
Consultant Gynecologist
Subspecialist in Reproductive Medicine
Newcastle Fertility Centre at Life
Bioscience Centre
International Centre at Life
Newcastle upon Tyne
UK
利益声明
JS declares that she has no competing interests.
Philip Savage, PhD, FRCP
Consultant in Medical Oncology
Department of Medical Oncology
Charing Cross Hospital
London
UK
利益声明
PS declares that he has no competing interests.
Aparna Sundaram, DO, MBA, MPH
Physician Consultant
Preventive Medicine
Private Practice
Atlanta
GA
利益声明
AS declares that she has no competing interests.
鉴别诊断
- 自然流产
- 多胎妊娠
- 盆腔肿瘤
更多 鉴别诊断指南
- 妊娠滋养细胞疾病（Green-top 指南第 38 号
- 妊娠滋养细胞疾病的诊断和治疗
更多 指南
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