妇科腹腔内出血175例临床分析

目的 :明确异位妊娠和黄体破裂所致腹腔内出血的临床特征以减少误诊。方法 :对因异位妊娠和黄体破裂所致腹腔内出血急诊入院的 175例患者的临床资料进行回顾性分析。结果 :异位妊娠 134例 ,占 76 .5 7% ,黄体破裂 41例 ,占 2 3.43%。异位妊娠腹腔内出血量为 10 5 1.32± 75 2 .12 ml,2 0 .6 9%患者出血量在 15 0 0 ml以上 ,2 2 .39%有昏厥史 ,停经 (82 .84% )、腹痛 (92 .5 4% )、阴道不规则出血 (76 .12 % )是主要的三联征。黄体破裂腹腔内出血量为 790± 6 39.15 ml,14.6 3%有昏厥史 ,腹痛 (97.5 6 % )是主要症状。内出血量两组比较差异有显著意义 ,P<0 .0 1。本资料 149例经手术止血 ,黄体破裂中 2 6例 (6 3.41% )经保守治疗成功。无一例死亡。结论 :详细询问病史 ,血 HCG检测和阴道 B超检查 ,后穹窿或腹腔穿刺是简便而重要的诊断手段     

异位妊娠与卵巢疾病的鉴别诊断

异位妊娠是常见妇科疾病,一旦破裂或流产导致腹腔内出血危及生命,其发生率近年呈上升趋势。国内异位妊娠与正常妊娠之比由1:167～322(1970年)上升至1:56～93(1989年)。由于诊断技术的提高,异位妊娠得以早期诊断,破裂率逐渐下降。但是异位妊娠误诊误治亦屡有报道,最常见的当属异位妊娠与卵巢疾病的混淆,包括:黄体和黄体囊肿破裂、卵泡和卵泡囊肿破裂、卵巢子宫内膜异位囊肿、卵巢肿瘤扭转或破裂;罕见的有卵巢黄素囊肿扭转或破裂,正常卵巢扭转等。有文献报道:仅卵巢破裂误诊为异位妊娠误诊率为34.5%,所以有必要对这组疾病进行鉴别诊断。1异位…     

22例卵巢黄体囊肿破裂急腹症分析

２２例卵巢黄体囊肿破裂急腹症分析邓小梅卵巢黄体囊肿破裂是妇科急腹症之一，常有不同程度的腹腔内出血，临床上易误诊异位妊娠．本文就我院１９８７年１月至１９９３年１０月经手术及病理确诊的２２例卵巢黄体囊肿破裂急腹症进行分析，以探讨提高诊断率的方法。一、临床...     

卵巢黄体囊肿破裂18例分析

急腹症是妇科常见疾病,有时因病史不清、症状不典型而被误诊为其他疾病。卵巢黄体囊肿破裂是妇科急腹症之一,常有不同程度的腹腔内出血,临床上易误诊异位妊娠。本文就我院１９８５年５月至１９９５年１０月经手术及病理确诊的１８例卵巢黄体囊肿破裂急腹症进行分析。一...     

经阴道彩色多普勒超声诊断卵巢妊娠的临床价值

目的探讨经阴道彩色多普勒超声对卵巢妊娠的诊断价值.方法对40例经病理证实的卵巢妊娠的术前经阴道彩色多普勒超声检测结果作回顾性分析.结果卵巢内胚囊型13例,卵巢表面不均质型16例,输卵管部位杂乱低回声型¨例.其中经阴道超声检查确诊29例(73%),误诊11例(27%),9例误诊为输卵管妊娠,2例误诊为妊娠黄体.结论经阴道彩色多普勒超声对诊断卵巢妊娠具有重要作用.     

卵巢妊娠22例临床分析

卵巢妊娠在异位妊娠中少见,因为缺乏典型的临床症状和体征,术前很难明确诊断,我院6年来经手术和病理证实为卵巢妊娠22例,与同期输卵管妊娠、黄体破裂进行比较如下。1资料与方法我院于1999年至2004年经手术病理证实卵巢妊娠22例,分别随机抽取同期输卵管妊娠30例、黄体破裂30例,进行对照分析,应用χ2、F、t检验。2结果2·1临床表现见表1。表1临床表现[n(%)]n停经腹痛阴道出血放环卵巢妊娠2215(68·18)22(100)6(27·27)9(40·91)输卵管妊娠3024(80·00)25(83·73)22(73·33)5(16·67)黄体破裂303(10·0)30(100)4(13·33)3(10·00)由表1可见,卵…     

继发腹腔妊娠误诊1例

患者25岁,住院号20735.因停经43天,阴道不规则流血18天,下腹部剧痛1小时于1998年6月23日入院。平素月经规律,本次月经1998年5月10日。1小时前无诱因突然下腹部剧痛,伴肛门坠胀,气短、心慌急症入院。该患者21天前曾因突然下腹部剧痛4小时入院,化验尿hCG（＋）,B超排除宫内妊娠,后穹窿穿刺抽出不凝血,拟诊：异位妊娠破裂？行剖腹探查手术。术中见：腹腔积血约1200ml,子宫及双侧输卵管正常,左侧卵巢囊肿破裂出血。行左侧卵巢部分切除及修补术。病理报告（病理号980228）：左侧卵巢黄体囊肿破裂。术后3天出现阴道不规则流血,量少…     

双侧卵巢巧克力囊肿足月妊娠产时破裂一例

双侧卵巢巧克力囊肿足月妊娠产时破裂一例淄博市淄川区医院孙萍山东省立医院王佩贞患者，３６岁，月经史：天，经血量中等。２０岁后出现痛且进行性加重，经期伴有腰疼，３５岁结婚，婚后２个月受孕，因阴道少量流血行Ｂ超检查，诊断为早孕合并双侧卵巢囊肿，右侧７５ｃｍ...     

宫内妊娠合并葡萄胎3例临床分析

目的:探讨宫内妊娠合并葡萄胎的临床特点、早期诊断及处理方法。方法:回顾分析2015年7月至2017年11月在华中科技大学同济医学院附属同济医院经临床及病理证实为宫内妊娠合并葡萄胎的3例孕妇的临床资料,包括临床特点、诊断与鉴别诊断及处理方法。结果:3例患者的年龄26~32岁,平均28.3岁;诊断孕周11~(+5)~17~(+2)周,平均孕15周;自然妊娠2例(66.7%)、体外受精-胚胎移植1例(33.3%);终止妊娠孕周12~(+4)~21~(+4)周,平均孕17~(+2)周。主要临床表现为反复阴道少量流血(100.0%)、咳嗽(66.7%)、恶心呕吐(66.7%)、卵巢黄素化囊肿(66.7%)、腹胀(33.3%)、甲状腺功能亢进症(33.3%)等。3例患者的血β-HCG均大于2×10~5m IU/ml,均通过B超早期诊断。结论:宫内妊娠合并葡萄胎患者在妊娠早期易出现反复阴道流血、咳嗽、恶心呕吐等不典型临床表现,可通过异常增高的血β-HCG及B超早期发现并诊断。     

经阴道穿刺配合药物治疗卵巢巧克力囊肿108例疗效观察

目的 :观察经阴道穿刺注入无水乙醇配合药物治疗卵巢巧克力囊肿的疗效。方法 :对 10 8例卵巢巧克力囊肿患者在阴道B超引导下行囊肿穿刺 ,注入无水乙醇之后随机分为 3组 :GnRHa组、内美通组、对照组。观察其缓解率、复发率、复发所需时间及妊娠率。结果 :缓解率GnRHa组 90 0 0 % ,内美通组 84 2 1% ,明显高于对照组 5 6 6 7%。复发率GnRHa组 12 5 % ,内美通组 2 1 0 5 % ,明显低于对照组 4 3 33%。妊娠率GnRHa组 2 7 5 % ,内美通组 2 3 6 8% ,明显高于对照组 6 6 7%。结论 :经阴道穿刺配合药物治疗卵巢巧克力囊肿缓解率、妊娠率较高 ,复发率低     

Ruptured corpus luteum with hemoperitoneum: a study of 173 surgical cases

Ovarian hemorrhage from the corpus luteum of menstruation or pregnancy can be a life-threatening surgical condition which occurs at all stages of a woman's reproductive life. A corpus luteum cyst predisposes to rupture. There may be a delay of menses. Pregnancy increases the risk of rupture, and there is an increased risk of abortion and ectopic pregnancy. Most ruptures occur in the right ovary and can be misdiagnosed as appendicitis. Culdocentesis is positive for hemoperitoneum, and if the hematocrit is over 12%, surgical intervention is indicated for hemostasis. A tissue diagnosis should be made by cystectomy, luteectomy, or wedge excision.     

A case of unruptured intrafollicular ovarian pregnancy diagnosed prior to operation

A case of an unruptured intrafollicular ovarian pregnancy of 8 gestational weeks diagnosed by ultrasonography in a virtually asymptomatic patient is reported. A 32 year-old woman with 1 vaginal delivery 8 years ago presented with a history of intermittent spotting after removal of an IUD during her last menstrual period 4 weeks ago. IUD was inserted 6 years prior. The patient was symptom-free and showed no abnormal findings upon vaginal examination. Transvaginal ultrasonography however disclosed a gestational sac with a live embryo within the left ovary. The woman was operated on via laparotomy without delay. The intraoperative finding showed a normally appearing corpus luteum in the intact left ovary without any visible abnormality of the pelvic organs. Having in mind the US finding a resection of the corpus luteum was done revealing the gestational sac within it. The authors describe the following three US signs specific of unruptured intrafollicular ovarian pregnancy: extremely thickened uniformly echogenic wall of the sac, the sac is partially surrounded by ovarian structure, no corpus luteum is detected in either ovary. The essential role of transvaginal ultrasonography in the precise diagnosis of the ectopic pregnancy and its location is emphasized. The absence of specific complaints and findings until rupture of the ovary occurs and the association of ovarian pregnancy and IUD are also confirmed by the case-report.     

Uterine and ovarian flow velocity waveforms in the normal menstrual cycle: a transvaginal Doppler study

A combined transvaginal 2D real-time and pulsed Doppler method was used for recording flow velocity waveforms in the uterine and ovarian arteries from 16 healthy women during the follicular and luteal phase of the normal menstrual cycle. Continuous forward end-diastolic flow velocities were documented in 74% of the ovarian artery and 96.5% of the uterine artery flow velocity waveforms. Comparison of the pulsatility index from the left and right ovarian artery revealed a significantly lower pulsatility index on the side of the ovary bearing the developing corpus luteum, suggesting reduced down-stream impedance or increased blood flow. The pulsatility index from the uterine artery only seems to be marginally involved in the observed impedance changes during the luteal phase of the menstrual cycle.     

Corpus luteum hemorrhage: rare complication of congenital and acquired coagulation abnormalities

Women taking anticoagulants or those with a clotting factor deficiency are at increased risk of corpus luteum rupture due to coagulation abnormalities and three such cases are described here. Case 1 was a 35-year-old woman with prosthetic mitral valve replacement who was on anticoagulant therapy, in whom hemoperitoneum secondary to ruptured corpus luteum was seen. Emergency laparotomy revealed 1.2 L of massive hemoperitoneum. Left salpingo-oophorectomy was performed. Case 2 was two episodes of hemoperitoneum from luteal cyst rupture in a young patient with the rare congenital factor X deficiency. This patient was managed conservatively with fresh frozen plasma and blood transfusion. This is the first case of congenital factor X deficiency manifested as luteal rupture to be managed conservatively. Case 3 was two episodes of hemoperitoneum from luteal cyst rupture in a patient with antiphospholipid antibody syndrome who was on oral anticoagulants. Laparotomy was done twice with left salpingo-oophorectomy in the first instance and partial excision of the right ovary in the second instance. Hemoperitoneum secondary to rupture of the corpus luteum should be considered in the differential diagnosis of acute abdominal pain in women with congenital and acquired coagulation deficiencies.     

Transition of ovarian arterial compliance during the human menstrual cycle, assessed by Doppler ultrasound--correlation with serum hormone levels

Ovarian arterial velocimetry was performed using color and pulsed Doppler ultrasound. Seventy-one examinations were done on 9 healthy women with regular menstrual cycles. The change in ovarian arterial compliance was based on the calculation of the pulsatility index (PI). In the active ovary carrying a dominant follicle or corpus luteum, PI in the early proliferative phase was significantly higher than that in the late proliferative phase (p less than 0.001), and PI in the early secretory phase was significantly lower than that in the late proliferative phase (p less than 0.001). PI became significantly higher in the late secretory phase than that in the early secretory phase (p less than 0.001). In the inactive ovary without a follicle of corpus luteum, no changes were seen among the values for PI, in any menstrual phase. There was a significant difference between the values for PI in the active ovary and the inactive ovary in the late proliferative, the early and the late secretory phases (p less than 0.001), respectively. The PI values for the active ovary significantly correlated with the serum progesterone levels (r = -0.53, p less than 0.05) but not with the estradiol levels. These findings provide a useful foundation for assessing ovarian hemodynamics during the menstrual cycle.     

Laparoscopic management of consecutive ovarian pregnancy in a patient with infertility

The diagnosis of ovarian pregnancy is based on the improper rise of serum beta-hCG levels, sonographic findings of an empty uterus, highly characteristic ovarian formation with double hyperechogenic ring surrounding small hypoechogenic field, and the laparoscopic verification of Spiegelberg's criteria. We present a case of ovarian pregnancy in spontaneous cycle in 34-year-old woman following two unsuccessful IVF/ET procedures and ovarian pregnancy on contralateral side laparoscopically treated seven months ago, also achieved in non-stimulated, spontaneous cycle. On admission she had a serum hCG level of 596 mIU/mL on cycle day 46 and an empty uterus. Transvaginal sonography showed a 20 mm ring-like thick-walled hyperechogenic structure within the left ovary. The echogenic ring was surrounded by irregular, hypoechogenic structures suggestive of an ovarian pregnancy with periluteal hemorrhage and blood clots. The ruptured cystic ovarian pregnancy and the corpus luteum were removed by laparoscopy. During the procedure we have seen two clips on the right ovary placed laparoscopically to achieve hemostasis after rupture of the ovarian pregnancy seven months ago. Histopathology showed isolated chorionic villi within hemorrhagic areas in the vicinity of the corpus luteum.     

Suppression of the ovary using a gonadotropin releasing-hormone agonist prior to stimulation for oocyte retrieval

Five women with prior suboptimal ovarian stimulation for in vitro fertilization and embryo transfer (IVF-ET) were pretreated with a long-acting gonadotropin-releasing hormone (GnRH) agonist beginning in the midluteal phase of the preceding menstrual cycle. The four women with normal luteal function had castrate estrogen levels following regression of the corpus luteum, whereas one woman with an abnormal luteal phase and perimenopausal levels of gonadotropins had an agonistic response. In the three women with adequate stimulation, 20 oocytes were obtained and one women became pregnant. Initiation of GnRH agonist therapy during the luteal phase of a normal menstrual cycle may be an efficient way of obtaining ovarian suppression without an agonistic response.     

Dextropreponderance of corpus luteum rupture. A clinical study

A retrospective study of 55 consecutive patients with cystic corpora lutea, corpus luteum cysts or hematomas was undertaken to verify the observation of a right-side predominance in the incidence of rupture. Thirty-nine patients had a ruptured corpus luteum diagnosed surgically and confirmed histologically. No difference was observed in the overall distribution, the volume of hemorrhage or the size of the cysts between the two sides. A statistically significantly higher incidence of rupture was found on the right side (81.25%) as compared to the left (56.52%). We propose a working hypothesis of a difference in the ovarian venous architecture that causes a higher intraluminal pressure in the right corpus luteum and the dextropreponderance of ruptures.     

Apoptosis in the human ovary

Programmed cell death or apoptosis is an essential component of human ovarian function and development. During early fetal life approximately 7 x 10(6) oocytes are formed in the human ovary. However, the number of oocytes is dramatically reduced already before birth through apoptotic cell death. In reproductive life, a number of primordial follicles start growing during each menstrual cycle. Usually only one will ovulate and the fate of the rest of the follicles is atresia through the mechanism of apoptosis. Ultimately, only around 400 follicles will ovulate during a woman's reproductive life. After ovulation, the dominant follicle forms the corpus luteum, a novel endocrine gland that is responsible for the production of progesterone and maintenance of endometrium during early pregnancy. If pregnancy does not occur, corpus luteum action must cease so that new follicles can resume growing during the next menstrual cycle. Apoptosis is also responsible for corpus luteum regression in the human ovary. In recent years, new knowledge of the role and regulation of apoptosis in the ovary has been acquired through the use of knockout and transgenic animals. Apoptosis seems to be the mechanism that makes the female biological clock tick. The following review will discuss the role of apoptosis and its regulation of human ovarian function.     

Presence of corpus luteum as evidence of ovulation in women treated with low doses of chlormadinone acetate

50 women under continuous treatment for 1-31 months with 500 mcg chlormadinone acetate daily were studied. Culdoscopy was performed between Day 14 and 23 of their menstrual cycles. A corpus luteum was thought to be observed in 37 cases. In 18 with suspected corpus luteum a wedge resection of the ovary was done. Examination of patients 10 days after operation revealed no complications. In 4 cases subsequent culdoscopic examinations revealed no traces of biopsy damage. In 5 an endometrial biopsy was obtained the same day as the ovarian one or shortly thereafter. The 18 ovarian biopsies showed recent corpora lutea in 12, old corpus luteum in 1, follicular and theca-lutein cysts in 2, and normal follicles without corpus luteum in 3. Endometrial biopsies revealed 2 instances of normal secretory endometrium and 1 case of irregular endometrium with corpora lutea. Evidence of ovulation occurred in 70%. The reported pregnancy rate with low-dose progestogen therapy has been 3.7/100 years of woman exposure. The exact mechanism of contraception by chlormadinone acetate has not been determined.