Terminology for describing normally
正常描述的术语
正常描述的术语
sited and ectopic pregnancies on
定点妊娠和异位妊娠
定点妊娠和异位妊娠
ultrasound: ESHRE recommendations
超声:ESHRE 建议
超声:ESHRE 建议
for good practice 良好实践
The ESHRE working group on Ectopic Pregnancy, Emma Kirk
ESHRE 异位妊娠工作组,Emma Kirk
ESHRE 异位妊娠工作组,Emma Kirk
1
,
Pim Ankum 皮姆·安库姆
2
, Attila Jakab 、Attila Jakab
3
, Nathalie Le Clef 、Nathalie Le Clef
4
, Artur Ludwin 、Artur Ludwin
5
,
Rachel Small 雷切尔·斯莫尔
6
, Tina Tellum , 蒂娜·泰勒姆
7
, Mira To , 杜美玲
̈yli
8
, Thierry Van den Bosch
, 蒂埃里·范登博斯
, 蒂埃里·范登博斯
9,10
,
and Davor Jurkovic 和 Davor Jurkovic
11,
*
1
Early Pregnancy and Emergency Gynaecology Unit, Royal Free Hospital London, London, UK
英国伦敦皇家自由医院早期妊娠和急诊妇科
英国伦敦皇家自由医院早期妊娠和急诊妇科
2
Amsterdam Medical Centre, Amsterdam,
阿姆斯特丹医疗中心, 阿姆斯特丹,
阿姆斯特丹医疗中心, 阿姆斯特丹,
the Netherlands 荷兰
3
Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
匈牙利德布勒森大学妇产科
匈牙利德布勒森大学妇产科
4
European Society of Human
欧洲人类学会
欧洲人类学会
Reproduction and Embryology, Belgium
比利时生殖与胚胎学
比利时生殖与胚胎学
5
Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow,
克拉科夫雅盖隆大学医学院妇科和肿瘤学系,
克拉科夫雅盖隆大学医学院妇科和肿瘤学系,
Poland 波兰
6
Heart of England NHS Foundation Trust, Birmingham, UK
英格兰之心 NHS 基金会信托基金,英国伯明翰
英格兰之心 NHS 基金会信托基金,英国伯明翰
7
Department of Gynecology, Oslo University Hospital, Ulleva
Ulleva 奥斯陆大学医院妇科
Ulleva 奥斯陆大学医院妇科
̊l, Oslo, ̊l, 奥斯陆,
Norway 挪威
8
Fertinova Clinics, Helsinki, Finland
Fertinova Clinics, 芬兰, 赫尔辛基
Fertinova Clinics, 芬兰, 赫尔辛基
9
Department of Obstetrics and Gynaecology, University Hospital Leuven, Belgium
比利时鲁汶大学医院妇产科
比利时鲁汶大学医院妇产科
10
Laboratory for Tumor Immunology and Immunotherapy, Leuven, KU, Belgium
肿瘤免疫学和免疫治疗实验室,比利时 Leuven
肿瘤免疫学和免疫治疗实验室,比利时 Leuven
11
Department of OB/GYN, University College Hospital,
大学学院医院妇产科
大学学院医院妇产科
London, UK 英国伦敦
*Correspondence address. Department of OB/GYN, University College Hospital, 235 Euston Road, London NW1 2BU, UK. E-mail:
*通讯地址。英国伦敦 NW1 2BU 尤斯顿路 235 号大学学院医院妇产科。电子邮件:
*通讯地址。英国伦敦 NW1 2BU 尤斯顿路 235 号大学学院医院妇产科。电子邮件:
davor.jurkovic@nhs.net; guidelines@eshre.eu
davor.jurkovic@nhs.net;guidelines@eshre.eu
davor.jurkovic@nhs.net;guidelines@eshre.eu
https://orcid.org/0000-0001-6487-5736
Submitted on October 6, 2020; resubmitted on October 9, 2020; editorial decision on October 15, 2020
提交于 2020 年 10 月 6 日;2020 年 10 月 9 日重新提交;2020 年 10 月 15 日的编辑决定
提交于 2020 年 10 月 6 日;2020 年 10 月 9 日重新提交;2020 年 10 月 15 日的编辑决定
STUDY QUESTION: 研究问题:
What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on
可以提供哪些建议来改进正常妊娠和异位妊娠描述的术语
可以提供哪些建议来改进正常妊娠和异位妊娠描述的术语
ultrasound? 超声波?
SUMMARY ANSWER: 总结答案:
The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and
本 ESHRE 文件就如何描述正常选址和
本 ESHRE 文件就如何描述正常选址和
different types of ectopic pregnancies on ultrasound.
超声检查不同类型的异位妊娠。
超声检查不同类型的异位妊娠。
WHAT IS KNOWN ALREADY: 已经知道的:
Current diagnostic criteria stipulate that each type of ectopic pregnancy can be defined by clear
目前的诊断标准规定,每种类型的异位妊娠都可以用 clear
目前的诊断标准规定,每种类型的异位妊娠都可以用 clear
anatomical landmarks which facilitates reaching a correct diagnosis. However, a clear definition of normally sited pregnancies and a
有助于做出正确诊断的解剖标志。然而,正常部位妊娠的明确定义和
有助于做出正确诊断的解剖标志。然而,正常部位妊娠的明确定义和
comprehensive classification of ectopic pregnancies are still lacking.
仍然缺乏对异位妊娠的全面分类。
仍然缺乏对异位妊娠的全面分类。
STUDY DESIGN, SIZE, DURATION:
研究设计、规模、持续时间:
研究设计、规模、持续时间:
A working group of members of the ESHRE Special Interest Group in Implantation and Early
ESHRE 植入和早期特别兴趣小组成员工作组
ESHRE 植入和早期特别兴趣小组成员工作组
Pregnancy (SIG-IEP) and selected experts in ultrasound was formed in order to write recommendations on the classification of ectopic
妊娠 (SIG-IEP) 和选定的超声专家成立,以便撰写关于异位分类的建议
妊娠 (SIG-IEP) 和选定的超声专家成立,以便撰写关于异位分类的建议
pregnancies. 怀孕。
PARTICIPANTS/MATERIALS, SETTING, METHODS:
参与者/材料、设置、方法:
参与者/材料、设置、方法:
The working group included nine members of different nationalities with
该工作组包括 9 名来自不同国籍的成员,他们
该工作组包括 9 名来自不同国籍的成员,他们
internationally recognised experience in ultrasound and diagnosis of ectopic pregnancies on ultrasound. This document is developed
国际公认的超声检查和超声异位妊娠诊断经验。本文档是开发的
国际公认的超声检查和超声异位妊娠诊断经验。本文档是开发的
according to the manual for development of ESHRE recommendations for good practice. The recommendations were discussed until
根据 ESHRE 良好实践建议制定手册。这些建议一直讨论到
根据 ESHRE 良好实践建议制定手册。这些建议一直讨论到
consensus by the working group, supported by a survey among the members of the ESHRE SIG-IEP.
工作组达成共识,并得到 ESHRE SIG-IEP 成员调查的支持。
工作组达成共识,并得到 ESHRE SIG-IEP 成员调查的支持。
MAIN RESULTS AND THE ROLE OF CHANCE:
主要结果和 CHANCE 的作用:
主要结果和 CHANCE 的作用:
A clear definition of normally sited pregnancy on ultrasound scan is important
超声扫描中正常妊娠位置的明确定义很重要
超声扫描中正常妊娠位置的明确定义很重要
to avoid misdiagnosis of uterine ectopic pregnancies. A comprehensive classification of ectopic pregnancy must include definitions and
以避免对子宫异位妊娠的误诊。异位妊娠的全面分类必须包括定义和
以避免对子宫异位妊娠的误诊。异位妊娠的全面分类必须包括定义和
descriptions of each type of ectopic pregnancy. Only a classification which provides descriptions and diagnostic criteria for all possible
每种类型的异位妊娠的描述。仅提供所有可能的描述和诊断标准的分类
每种类型的异位妊娠的描述。仅提供所有可能的描述和诊断标准的分类
locations of ectopic pregnancy would be fit for use in routine clinical practice. The working group formulated 17 recommendations on the
异位妊娠的部位适合用于常规临床实践。工作组就
异位妊娠的部位适合用于常规临床实践。工作组就
diagnosis of the different types of ectopic pregnancies on ultrasound. In addition, for each of the types of ectopic pregnancy, a schematic
超声诊断不同类型的异位妊娠。此外,对于每种类型的异位妊娠,都有一个示意图
超声诊断不同类型的异位妊娠。此外,对于每种类型的异位妊娠,都有一个示意图
representation and examples on 2D and 3D ultrasound are provided.
提供了 2D 和 3D 超声的表示和示例。
提供了 2D 和 3D 超声的表示和示例。
LIMITATIONS, REASONS FOR CAUTION:
限制、谨慎原因:
限制、谨慎原因:
Owing to the limited evidence available, recommendations are mostly based on clinical
由于可用证据有限,建议主要基于临床
由于可用证据有限,建议主要基于临床
and technical expertise. 和技术专长。
ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
V
C
The Author(s) 2020. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.or
g/licenses/by-nc/4.0/), which permits
non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please c
ontact journals.permissions@oup.com
Human Reproduction Open, Vol.00, No.0, pp. 1–21, 2020
人类生殖公开赛,第 00 卷,第 0 期,第 1-21 页,2020 年
人类生殖公开赛,第 00 卷,第 0 期,第 1-21 页,2020 年
doi:10.1093/hropen/hoaa055
doi:10.1093/hropen/hoaa055
doi:10.1093/hropen/hoaa055
ESHRE PAGES ESHRE 页面
Downloaded from https://academic.oup.com/hropen/article/2020/4/hoaa055/6038915 by guest on 24 December 2020
客人于 2020 年 12 月 24 日从 https://academic.oup.com/hropen/article/2020/4/hoaa055/6038915 下载
客人于 2020 年 12 月 24 日从 https://academic.oup.com/hropen/article/2020/4/hoaa055/6038915 下载
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
WIDER IMPLICATIONS OF THE FINDINGS:
This document is expected to have a significant impact on clinical practice in ultrasound
for early pregnancy. The development of this terminology will help to reduce the risk of misdiagnosis and inappropriate treatment.
STUDY FUNDING/COMPETING INTEREST(S):
The meetings of the working group were funded by ESHRE. T.T. declares speakers’
fees from GE Healthcare. The other authors declare that they have no conflict of interest.
TRIAL REGISTRATION NUMBER:
N/A
DISCLAIMER:
This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus
between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation.
ESHRE’s GPRs should be used for informational and educational purposes. They should not be interpreted as setting a standard of care or
be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same
results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality
and facility type. Furthermore, ESHRE’s GPRs do not constitute or imply the endorsement, recommendation or favouring of any of the in-
cluded technologies by ESHRE.
Key words:
ectopic pregnancy / terminology / ultrasound / early pregnancy / ESHRE / guideline
Introduction
Ultrasound is the most commonly used imaging modality for assessing
women with suspected early pregnancy complications. An early preg-
nancy ultrasound examination has three main objectives: (i) to confirm
the location and number of pregnancies, (ii) to establish whether a
normally implanted pregnancy has the potential to develop further be-
yond the first trimester and (iii) to assess the risk to maternal health
posed by ectopic pregnancy.
Most ultrasound examinations undertaken in early pregnancy are
performed using a transvaginal route. This facilitates detailed studies of
pelvic organs and earlier and more accurate detection of various devel-
opmental markers in early pregnancy than a transabdominal scan
(
Cacciatore
et al.
,1989
). There are, however, cases when a transab-
dominal scan is also indicated, such as in those with a large fibroid
uterus or adhesions fixing the uterus to the anterior abdominal wall.
Although progress has been made in reaching a consensus on crite-
ria for differentiating between potentially ongoing (live) and failing first-
trimester pregnancies (miscarriages) (
Doubilet
et al.
,2013
), there has
been little work on refining the criteria for the diagnosis of pregnancy
location and differentiating between normally and abnormally sited
pregnancies. The first step towards improving ultrasound diagnosis of
ectopic pregnancy is a clear agreement on the definition of a preg-
nancy which is implanted in the correct physiological place. Following
that, there should also be a consensus regarding diagnostic criteria to
differentiate between various types of ectopic pregnancies. Current di-
agnostic criteria stipulate that each type of ectopic pregnancy can be
defined by clear anatomical landmarks which facilitates reaching a cor-
rect diagnosis (
Elson
et al.
, 2016
)
.
However, there are no defined
anatomical barriers between the uterine cavity, Fallopian tubes and ab-
dominal cavity. In fact, pregnancies can potentially implant anywhere
along this passage from the ovary to the cervical canal, with some
pregnancies being partially implanted within and partially outside the
uterine cavity (
Jurkovic
et al.
, 2003
)
.
A comprehensive classification of
ectopic pregnancy must allow for these possibilities. Only a classifica-
tion which provides descriptions and diagnostic criteria for all possible
locations of ectopic pregnancy would be fit for use in routine clinical
practice. Development of uniform terminology will also help to reduce
the risk of misdiagnosis and inappropriate treatment. A good example
of this problem has been inconsistent use of the term ‘cornual’ preg-
nancy which has been used to describe a wide range of pregnancy
locations from normal pregnancies implanted in the lateral aspect of
the uterine cavity through to interstitial pregnancies and pregnancies in
the rudimentary cornu of unicornuate uterus (
Baltarowich, 2017
).
Treatment of ectopic pregnancies was beyond the scope of our rec-
ommendations and has not been addressed in this manuscript.
Materials and methods
ESHRE recommendations for good practice are developed based on
the Manual for development of recommendations for good practice,
which can be consulted at the ESHRE website (www.eshre.eu/guide
lines
). The manual describes a nine-step procedure for writing recom-
mendation documents.
This current paper was initiated by the ESHRE Special Interest
Group in Implantation and Early Pregnancy (SIG-IEP). In the first phase,
information on commonly used terminology in ectopic pregnancy and
WHAT DOES THIS MEAN FOR PATIENTS?
This paper describes good practice recommendations for terminology to describe normally sited and ectopic pregnancies on ultrasound. By
describing the exact locations of the ectopic pregnancies, this terminology should help to reduce the risk of misdiagnosis and inappropriate
treatment. These technical recommendations are not directly relevant to patients, but they should ensure that patients encountering an ec-
topic pregnancy receive the best care possible.
2
Kirk
et al.
Downloaded from https://academic.oup.com/hropen/article/2020/4/hoaa055/6038915 by guest on 24 December 2020