小结
定义
病史和体格检查
关键诊断因素
- 腹痛
- 闭经
- 阴道出血
- 腹部压痛
- 附件压痛或肿块
- 阴道穹窿有积血
- 血液动力不稳、直立性低血压
- 宫颈举痛
其他诊断因素
- 便意
- 肩部牵涉痛
危险因素
- 既往异位妊娠
- 既往输卵管绝育手术
- 母亲子宫内己烯雌酚暴露
- 宫内节育器 (IUD) 的使用
- 既往生殖器感染
- 慢性输卵管炎
- 峡部结节性输卵管炎
- 不育症
- 多名性伴侣
- 吸烟
- 种族/族群
- 辅助生殖技术 (assisted reproductive technology, ART)
- 初次性行为年龄＜18 岁
- 孕妇年龄＞35 岁
- 输卵管再造术
诊断性检查
首要检查
- 尿液或血清妊娠试验
- 高分辨率经阴道超声 (TVUS)
- 经腹超声
需考虑的检查
- 连续血清人绒毛膜促性腺激素（hCG）
- 吸宫术
治疗流程
输卵管异位妊娠：异位妊娠破裂或药物治疗失败
输卵管异位妊娠：中度风险或期待治疗失败
输卵管异位妊娠：低风险
撰稿人
作者
Kurt T. Barnhart, MD, MSCE
William Shippen Jr. Professor of Obstetrics and Gynecology and Epidemiology
Vice Chair for Clinical Research
Director, Women's Health Clinic Research Center
The Perelman School of Medicine
University of Pennsylvania
Associate Chief, Penn Fertility Care
Philadelphia
PA
利益声明
KTB is a co-author on several papers cited in this topic.
鸣谢
Dr Kurt T. Barnhart would like to gratefully acknowledge Dr Ingrid Granne, Dr Veronica Gomez-Lobo, Dr Sina Haeri, and Dr Mohammad Ezzati, previous contributors to this topic.
利益声明
IG, VGL, SH, and ME declare that they have no competing interests.
同行评议者
Alan Decherney, MD
Chief
Reproductive Biology Medicine and Biology
NICHD
Bethesda
MD
利益声明
AD declares that he has no competing interests.
Joanna C. Girling, MA, MRCP, FRCOG
Consultant in Obstetrics and Gynaecology
West Middlesex University Hospital
London
UK
利益声明
JCG declares that she has no competing interests.
鉴别诊断
- 流产
- 急性阑尾炎
- 卵巢扭转
更多 鉴别诊断指南
- 宫外孕和流产：诊断和初始管理
- Management of pregnancy of unknown location and tubal and nontubal ectopic pregnancies
更多 指南患者教育信息
异位妊娠：是什么？
异位妊娠：哪些治疗有效？
更多 患者教育信息
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