Related Research On Rapid Diagnosis Technology Of Early Ectopic Pregnancy

Objective:By measuring the hCG ratio(Rp/v-hCG)of pelvic and abdominal blood and venous blood in suspected ectopic pregnancy patients with pelvic and abdominal hemorrhage or by measuring the hCG vaginal ultrasound threshold of venous blood in suspected ectopic pregnancy patients without pelvic hemorrhage Combined with the thickness of the endometrium,the diagnosis cycle of ectopic pregnancy can be shortened,the sensitivity and specificity of the diagnosis of early ectopic pregnancy can be improved,and the diagnosis plan of early ectopic pregnancy can be more accurate and fast.Methods:The patients who were treated in Shengjing Hospital Affiliated to China Medical University from August 2019 to November 2020 were prospectively selected,and the patients were divided into 2 groups according to their general conditions and physical signs.For patients with clinical sexual life,history of menopause,no pregnancy sac in the uterus,ectopic pregnancy suspected to have pelvic and abdominal hemorrhage,select the pelvic blood group,draw venous blood and pass through posterior fornix puncture or intraoperative extraction at the same time Obtain pelvic and abdominal blood samples from pelvic and abdominal hemorrhage,check the hCG of pelvic abdominal blood and venous blood,and then calculate the ratio of abdominal blood to venous blood index.For patients with clinical sexual life,history of menopause,no pregnancy sac in the uterus,suspected ectopic pregnancy and no pelvic hemorrhage,the ultrasound group was selected to test the hCG of their venous blood,and at the same time,the transvaginal ultrasound was used to measure the hCG.The endometrial thickness was taken,and the endometrial thickness was 10 mm and the venous blood hCG was 1500IU/L as the predictive value of ectopic pregnancy and the patients were followed up.Select patients diagnosed with ectopic pregnancy after follow-up,and randomly select patients with normal intrauterine pregnancy,compare the endometrial thickness and venous blood hCG value of the two groups of patients,and draw the single item of endometrial thickness and venous blood hCG value.The ROC curve of detection and venous blood hCG vaginal ultrasound threshold combined with endometrial thickness detection,compare the area under the curve,sensitivity and specificity.We retrospectively selected patients who were treated at Shengjing Hospital Affiliated to China Medical University from August 2019 to November 2020 and were finally diagnosed with cesarean section scar pregnancy and ovarian pregnancy through surgical treatment.They were divided into cesarean section scar pregnancy group.And the ovarian pregnancy group,and retrospective analysis of the two groups of patients to analyze whether there are differences in venous blood hCG and endometrial thickness in the first trimester compared with patients with normal intrauterine pregnancy.If there is a difference,take the conclusion of the ultrasound group as the predictive value,and analyze the sensitivity and specificity of the early diagnosis of the group.Further draw the ROC curve of single detection of endometrial thickness,single detection of venous blood hCG value,and venous blood hCG vaginal ultrasound threshold combined with endometrial thickness detection ROC curve,explore the threshold,compare the area under the curve,sensitivity and specificity,and judge it in the early stage The value of clinical application in the diagnosis of early cesarean section scar pregnancy and ovarian pregnancy.Results:There were a total of 20 patients in the pelvic blood group(measured Rp/v-hCG),and 20 patients all met Rp/v-hCG>1.After follow-up,all patients were finally treated with surgery.The postoperative pathological diagnosis was tubal pregnancy.The accuracy rate was 100%(20/20).In the ultrasound group(measure venous blood hCG,vaginal ultrasound to measure endometrial thickness),the endometrial thickness was10 mm and the venous blood hCG was 1500IU/L as the predictive value.A total of 54 patients were enrolled in the group,and the patients were finally treated with surgery after follow-up.In 50 cases,pathological diagnosis confirmed that they were all tubal pregnancy,with an accuracy rate of 92.59%(50/54).The venous blood hCG(2984.85±105.44IU/L)and endometrial thickness(7.65±1.31mm)of the 50 ectopic pregnancy patients were lower than those of intrauterine pregnant women,the difference was statistically significant(t=20.257 and t= 60.254,P<0.05).The area under the ROC curve of hCG vaginal ultrasound threshold combined with endometrial thickness in venous blood was 0.911,the sensitivity was 0.930,and the specificity was 0.878.Compared with the single test of blood hCG(0.733/0.880/0.827)and the single test of endometrial thickness(0.753/0.820/0.596),it is higher than the single test.The threshold is 9.5mm endometrial thickness and venous blood hCG1468.5IU/ L.Compared with single detection of blood hCG or vaginal ultrasound to measure endometrial thickness,venous blood hCG vaginal ultrasound threshold combined with endometrial thickness detection is more accurate and sensitive in the diagnosis of early ectopic pregnancy,and the diagnostic value is higher.The endometrial thickness and blood hCG of the cesarean section scar pregnancy group were not significantly different from those of normal intrauterine pregnancy patients in the early trimester(t=15.424 and t=84.114,its P> 0.05).The venous blood hCG(3426.51±2726.98mm)and endometrial thickness(9.57±1.47mm)of the ovarian pregnancy group were lower than those of pregnant women in utero,the difference was statistically significant(t=15.314 and t=7.521,both P< 0.05).Taking the conclusion of the ultrasound group as a positive indicator,the sensitivity of hCG vaginal ultrasound threshold combined with endometrial thickness was 0.920,and the specificity was 0.840,compared with blood hCG single test(0.900/0.580)and single endometrial thickness test(0.860/ 0.620),which are higher than the single test.The area under the ROC curve of hCG vaginal ultrasound threshold combined with endometrial thickness in venous blood was 0.891,the sensitivity was 0.980,and the specificity was 0.878.Compared with the single test of blood hCG(0.755/0.920/0.654)and the single test of endometrial thickness(0.745/0.880/0.692),it is higher than the single test.The threshold is 10.5mm for endometrial thickness and hCG1514IU/L for venous blood.It is not much different from the ultrasound group.Venous blood hCG vaginal ultrasound threshold combined with the diagnosis of endometrial thickness is helpful for the diagnosis of ovarian pregnancy.Conclusion: By measuring the hCG ratio(Rp/v-hCG)of pelvic and abdominal blood and venous blood,it can quickly assist in the diagnosis of ectopic pregnancy in patients with pelvic and abdominal hemorrhage,with high specificity.Venous blood hCG vaginal ultrasound threshold combined with endometrial thickness can quickly and accurately assist in the diagnosis of ectopic pregnancy such as tubal pregnancy and ovarian pregnancy,and has certain significance for the diagnosis and treatment of early ectopic pregnancy.In cesarean section scar pregnancy,there is no significant difference in venous blood hCG and endometrial thickness in early pregnancy and intrauterine pregnancy.It is necessary to further combine other detection methods to determine the location of pregnancy.