子宫角妊娠4例分析

目的探讨子宫角妊娠的诊断及治疗方法，减少误诊率。方法分析我院1998—2005年7年内收治的子宫角妊娠4例进行临床分析并复习相关文献。结果术前误诊2例，其中1例因延误手术时机而死亡，1例术中才明确诊断；1例孕早期B超确诊后在B超监测下行人工流产；另1例发生破裂后B超诊断为官角妊娠行剖腹探查证实。结论 妊娠早期常规B超检查及引产前常规B超检查，提示胎盘是否位于子宫角部，可减少子宫角妊娠的误诊及破裂。该病极易与输卵管间质部妊娠相混淆。根据Jansen等对子宫角妊娠的诊断标准可与输卵管间质部妊娠相鉴别。     

B型超声诊断子宫角妊娠

Ｂ型超声诊断子宫角妊娠房瑜，张子云，潘小利（连云港市第一人民医院妇产科）子宫角妊娠临床较罕见，但常在妊娠过程中发生流产，子宫破裂，胎盘植入，胎盘粘连等造成严重后果。１９８７年以来我们用Ｂ型超声（Ｂ超）诊断２例子宫角妊娠，均经手术证实，报告如下。１Ｂ超...     

子宫角部妊娠1例

患者 30岁 ,住院号 15 5 34。因停经 2个月 ,不规则阴道流血 1个月 ,于 2 0 0 3年 4月 9日入院。平素月经规律 ,孕 3产 0 ,末次月经 2 0 0 3年 2月 9日 ,停经 2 6d起阴道少量流血 ,暗红色。停经 38d查尿妊娠试验阳性 ,B超示宫内1 1cm妊娠囊 ,在门诊行人流术 ,吸出物未见绒毛。 1周后患者仍有早孕反应 ,复查B超报宫内见 2 0cm× 1 0cm混合回声 ,再次刮宫 ,刮出物仍未见绒毛。 2周后患者仍有少量阴道流血 ,查血 β HCG为 15 6 6IU/L(>5IU/L为妊娠或其他疾病 ) ,B超见宫腔左侧一个 1 4cm× 1 1cm混合回声 ,故在B超引导下行异物吸刮术 ,…     

子宫角部妊娠破裂继发腹腔妊娠一例

患者　 36岁 ,因妊娠 34周 + 6,下腹疼痛 2ｈ ,于 2 0 0 1年11月 2 2日 2 2时急诊入院。产妇末次月经 2 0 0 1年 3月 2 1日 ,停经 4 0ｄ阴道少量出血 ,伴下腹剧痛 ,予保胎治疗。停经 2个月Ｂ超提示 :宫内胚胎发育未见异常。此后无阴道出血 ,但下腹痛时重时轻 ,停经 3个月后腹痛逐渐缓解 ,自觉有胎动 ,孕 7个月再次出现下腹疼痛 ,可以忍受 ,且全身水肿明显。近半个月出现尿频 ,排尿不畅 ,于 2 0 0 1年 11月 19日行产前检查 ,血压 16 5 / 78ｍｍＨｇ(1ｍｍＨｇ=0 133ｋＰａ) ,尿蛋白(+++) ,Ｂ超提示胎儿头位 ,胎盘成熟度Ⅰ级。于 2 0 0 1年 1…     

子宫角部妊娠术后继发腹腔妊娠一例

患者 4 1岁 ,孕 5产 2 ,因停经 7个月胎动异常 1周 ,于2 0 0 2年 3月 16日入院。患者平素月经规律 ,L MP2 0 0 1年 8月 2 0日。 1991年因左侧宫角妊娠行左侧宫角及附件切除。停经 2个月时出现下腹痛持续 2 d,停经 4个月余自觉胎动 ,胎动时伴腹痛 ,近一周觉胎动异常于当地医院就诊 ,超声示宫内葡萄胎合并腹腔妊娠 ,遂来我院检查。彩超诊为腹腔妊娠 ,胎儿横位合并宫颈峡部肌瘤 6 .6 cm× 6 .2 cm× 6 .0 cm。查体 :体温 37.4℃ ,脉搏 75次 /m in,血压 12 5 /90 mm Hg(1mm Hg=0 .133k Pa) ,轻度贫血貌 ,心肺听诊无异常 ,腹膨隆 ,肝脾未触及 …     

子宫角妊娠16例临床分析

子宫角妊娠１６例临床分析陈素清，陈水仙子宫角妊娠较为罕见，临床诊断困难，在妊娠过程中经常发生流产、子宫角破裂及胎盘滞留等。规将我院经手术和病理证实的１６例的诊断、鉴别诊断及处理等分析如下。一、临床资料１．一般资料：１９８２年８月至１９９３年９月，我院...     

纵隔子宫妊娠误诊为宫角部妊娠1例

一、病例摘要患者32岁,孕1产1,未放环。平日月经规律,色红量中无痛经,白带不多。末次月经2003年2月11日,色量正常,于3月26日测尿妊娠实验(+),B超诊断为“早孕”,即在我院行人工流产术。术中仅刮出少量蜕膜组织,未见典型绒毛,嘱患者半个月后复查。术后患者阴道流血不多,无腹痛及发热,但恶心、乏力等早孕反应持续存在,即于4月5日来院复查,尿妊娠实验(+),B超:见宫内孕囊,大小约3.1cm×2.6cm,位置略偏左侧宫角部。妇科检查:外阴、阴道正常,分泌物不多,宫颈光滑,子宫前位,增大如孕50d,形态规则,质软,无压痛,双附件未触及异常。即决定在B超监测…     

剖宫产术后子宫峡部妊娠3例分析

例 1　患者 2 7岁。住院号 0 0 6 6 5 32。孕 1产 0。末次月经 2 0 0 0年 3月 30日 ,曾于 1 999年 5月 1 3日行剖宫产术。自述 1周前在外院B超诊断为 :早孕、子宫角部妊娠。入院后做B超回报 :子宫大小为 78mm× 5 4mm× 5 8mm ,轮廓清晰 ,边缘欠规则。妊娠囊位于子宫下段与前壁肌壁处 ,边缘距浆膜层约 2mm ,大小为 39mm× 2 7mm ,未见明显心管搏动。入院后确定诊断为 :孕 1 0周、孕 1产 0 ,子宫峡部妊娠。 2 0 0 0年 6月 9日始给予MTX 0 4mg/ (kg·d)肌注4d ,2 0 0 0年 6月 1 2日 8时出现阴道少量流血 ,当日 1 1时在B超监护下行清宫术。…     

子宫角部妊娠（附18例分析）

子宫角部妊娠（附１８例分析）谢曼琳，邵敬於（上海市第一妇婴保健院）宫角妊娠系异位妊娠的一种，较罕见，仅占１％～７％。因宫角位于输卵管通往子宫的交界处，肌组织较薄，又是子宫卵巢动静脉与输卵管吻合处，血运丰富。且孕周较长，因此宫角妊娠一旦破裂，出血量多，...     

残角子宫妊娠1例分析

残角子宫妊娠１例分析董瑞英，张向宁，陈建利（山东医科大学附属医院）１病例摘要患者２６岁，因停经１６５７周，死胎，于１９９６年５月３日收入院。患者停经以来，无阴道流血、流水。月经史：１４４ ５２８ ３０，量正常，经期腹疼剧烈，生育史：Ｇ０。体格...     

瘢痕子宫孕妇孕中晚期引产的方法探讨

目的 探讨瘢痕子宫孕妇孕中晚期引产的适宜方法.方法 选择2002年9月-2009年6月在首都医科大学附属北京妇产医院因医疗指征于孕中晚期引产的瘢痕子宫孕妇共90例,引产指征为胎儿畸形、严重妊娠并发症、胎死宫内.其中,孕中期72例,孕晚期18例;距离前次子宫手术的间隔时间<2年20例,≥2年70例.肝功能正常者服用米非司酮,并行利凡诺过敏试验,阴性者首选利凡诺羊膜腔注射引产法;试验阳性、羊水过少、孕周过小、利凡诺羊膜腔注射困难或注射失败者采用卡前列甲酯(卡孕栓)引产法.共有54例孕妇采用利凡诺引产(利凡诺组),36例孕妇采用卡孕栓引产(卡孕栓组).(1)记录两组孕妇入院时情况,包括年龄、孕周、孕次、产次;(2)前次导致子宫瘢痕的手术种类、手术方法、有无并发症、前次手术间隔时间;(3)此次妊娠的引产方法,并记录孕妇用药至宫缩发动的时间,用药至胎儿娩出的时间;(4)产后出血量,胎盘滞留率,引产成功率,有无子宫破裂及行全子宫切除术等情况.结果 (1)利凡诺组与卡孕栓组孕妇的年龄、孕次、产次、距前次子宫手术间隔时间比较,差异均无统计学意义(P>0.05).但两组孕妇的引产孕周比较,差异有统计学意义(P<0.01).(2)两组孕妇引产的成功率及产后出血量比较,差异无统计学意义(P>0.05),但卡孕栓组孕妇引产用药后宫缩发动的时间及分娩时间明显短于利凡诺组,两组比较,差异有统计学意义(P<0.01);卡孕栓组孕妇24 h内分娩率达到94%(34/36),明显高于利凡诺组的13%(7/54),两组分别比较,差异均有统计学意义(P<0.01).(3)卡孕栓组孕妇胎盘滞留率(31%,11/35)明显高于利凡诺组(10%,5/52);而利凡诺组胎盘胎膜残留率(54%,28/52)明显高于卡孕栓组(34%,12/35),两组分别比较,差异均有统计学意义(P<0.01).但两组孕妇总的产时并发症发生率比较,差异无统计学意义(P>0.05).不良事件发生与前次子宫手术间隔时间的关系分析显示,<2年的孕妇在胎盘滞留、胎盘胎膜残留、胎盘早剥、子宫破裂、产后出血的发生率分别与≥2年的孕妇比较,差异均无统计学意义(P>0.05).(4)卡孕栓组孕妇中有1例发生子宫破裂,利凡诺组孕妇中有1例宫缩发动1 h后发生胎盘早剥.结论 对瘢痕子宫孕妇于孕中晚期应用利凡诺羊膜腔注射引产和卡孕栓阴道用药引产均是可行的,但需在充分的术前准备及严密监护下进行,以警惕子宫破裂的发生.     

Medical and ethical considerations in uterus transplantation

Transplanting a uterus has unique characteristics, since a successful outcome is represented only by the birth of a viable healthy child. For this reason, critical issues in this type of transplantation differ profoundly from those of other solid organs and, beside a functioning uterus, involve 3 additional steps. First, at the time of implantation, the quality of embryo is tested by specialized decidual cells surrounding the implanting embryo; such testing is aimed at allowing the development of a normal embryo. Second, from early gestation onward, blood supply to the uterus increases from 45 to 750 mL per minute. Vascular anastomoses should support such a marked increase in blood flow. Third, full transformation of spiral arterioles in the placental bed is required to direct 75% of the uterine blood flow to the intervillous space. Unfortunately, no suitable animal model is available for experimentation. Three overarching ethical issues must be considered. Should organ transplant be conducted when it is not absolutely necessary as a life-saving or quality-of-life-saving measure? To what extent should medicine delimit its potential in spite of societal desires? Should society demand from medicine the application of whichever technology can be developed and, if so, to what extent?     

新式剖宫产术后子宫复旧及子宫切口愈合情况的B超监测

目的观察新式剖宫产子宫复旧和子宫切口愈合情况。方法两组各150例,观察组行新式剖宫产术,对照组行传统子宫下段剖宫产术。于术后7天、30天分别行盆腔B超检查观察子宫复旧及子宫切口愈合情况。结果两组病例术后7天、30天子宫各径线大小无显著差异(P＞0.05);对照组术后30天宫腔积液发生率显著高于观察组(P＜0.05);观察组术后30天子宫切口回声区域的纵径显著小于对照组(P＜0.05);观察组术后30天子宫切口A型愈合率显著高于对照组(P＜0.05)。结论新式剖宫产术因子宫切口局部缝线少、异物反应小、吸收快,是有利于子宫复旧和子宫切口愈合的手术方式。     

Changes of the uterine proteoglycan distribution at term pregnancy and during labour

Objective: To characterise uterine proteoglycans and changes therein during pregnancy and labour. Study Design: Uterine samples were collected from 6 non-pregnant, 10 term-pregnant and from 10 women in active labour. The proteoglycans were extracted by 4 M guanidine hydrochloride and precipitated with Alcian Blue. They were separated by electrophoresis and identified by Western blotting. Results: Decorin was the dominating proteoglycan and smaller amounts of biglycan was found. A considerable amount of heparan sulphate proteoglycans was also detected. Decorin and biglycan decreased by 40% until term. The amount of heparan sulphate proteoglycans increased by 46% during active labour. Conclusion: Our data indicate that a considerable remodelling of the uterine connective tissue occurs during pregnancy and labour. The decrease of decorin and biglycan and the increase of heparan sulphate proteoglycans may be important for normal myometrial contractions during labour.     

Adnexal torsion in late pregnancy

We report a case of adnexal torsion in a singleton pregnancy at 27 weeks of gestation. Adnexal torsion during pregnancy is a rare condition, and it is quite exceptional during the third trimester. The symptoms are non-specific and can be confused with other acute abdominal disorders. In our case, ultrasound allowed an accurate preoperative diagnosis.     

Unique case of successful twin pregnancy after spontaneous conception in a patient with uterus bicornis unicollis

Introduction Abnormal fusion of the mullerian ducts or failure of absorption of the septum causes varying degrees of congenital uterine malformation. Twin gestation in a case of bicornuate uterus is extremely rare. We are reporting this case because of its extremely rare presentation, where twins have managed to reach term after spontaneous conception. Case report A 28-year-old second gravida, para one was initially diagnosed to have diamniotic dichorionic twins on ultrasound. At term, she was referred to us with severe pre-eclamptic toxaemia. On examination, she was found to have a bicornuate uterus with one fetus in each horn. Both siblings were successfully delivered by caesarean section. So far, only one similar case has been reported following in vitro fertilisation. Conclusion Although poor reproductive performance has been documented in previous reports of bicornuate uterus with twin gestation, our patient managed to reach term with delivery of healthy siblings by caesarean section.