体外受精-胚胎移植后宫内妊娠合并瘢痕妊娠一例

报道1例体外受精-胚胎移植（IVF-ET）后宫内妊娠合并子宫瘢痕妊娠（CSP）的病例。该患者取卵3枚,成功配成3枚胚胎,移植胚胎3枚,成功着床2枚,但1枚在宫内正常位置上,1枚着床在前次剖宫产切口上。该患者对瘢痕处的妊娠囊行减胎术后,因持续不规则阴道出血来医院就诊,妇科超声检查提示,宫腔内可见2个胎囊,其一可见胎芽,胎心（+）,其二位于前次剖宫产切口处,仅见胎囊,其内未见卵黄囊及胎芽,形态不规则。最终行经腹宫腔内胎盘胎儿清除术+CSP病灶切除术+剖宫产瘢痕憩室修补术,终止妊娠。报道此特殊病例,将CSP的超声和磁共振成像（MRI）诊断技术的优缺点进行比较,并对CSP的治疗和预防提出一些思考。     

宫颈妊娠及宫内孕合并宫颈妊娠的保守治疗

目的:探讨宫颈妊娠的病因、诊断及保守性治疗方法。方法:回顾分析我院1996年1月1日至2010年12月31日收治的宫颈妊娠及体外授精胚胎移植术后宫内孕合并宫颈妊娠患者36例,探讨宫颈妊娠保守治疗方式的选择,并随访患者术后情况。结果:29例单纯宫颈妊娠:6例外院误诊为"难免流产",误诊率20.69%;10例经阴道B超引导下宫颈妊娠囊局部穿刺+MTX注射治疗,6例行子宫动脉栓塞术,6例MTX肌内注射治疗,7例腰麻下宫腔镜检查宫颈妊娠清除手术。7例宫内孕合并宫颈妊娠:1例阴道B超引导下局部妊娠囊穿刺注入KCl 1ml,3例期待疗法后清除宫颈妊娠物,3例腹部B超引导下宫颈妊娠物清除术。结论:阴道彩超用于宫颈妊娠的早期诊断有较大的价值,术前应充分评估,制定个体化的治疗方案。宫内孕合并宫颈妊娠的患者在腹部B超监测下清除宫颈妊娠物是有效的治疗方式之一,但要及时手术并且加强抗感染治疗。     

选择性减胎术成功治疗子宫疤痕妊娠合并宫内妊娠1例报道及文献复习

目的:探讨子宫疤痕妊娠合并宫内妊娠的选择性减胎术的治疗效果。方法:报道1例孕7周确诊为子宫疤痕妊娠合并宫内妊娠患者,经阴道超声指导下实施疤痕妊娠胚胎抽吸减胎术,同时进行文献复习。结果:成功实施了选择性减胎术,疤痕妊娠被终止,宫内妊娠继续,于孕35+3周剖宫产分娩一健康婴儿,无并发症发生。结论:疤痕妊娠选择性减胎术对需要保留宫腔妊娠的患者是侵入性最小且比较安全的治疗方法。     

体外受精-胚胎移植术后复合妊娠的临床特点及研究进展

复合妊娠(HP)是一种特殊类型的异位妊娠,病情复杂、隐匿,易被误诊为单纯宫内孕而宫外妊娠被漏诊,二次住院及大出血的风险高于单部位异位妊娠。随着辅助生殖技术的发展,HP发生率逐年升高。体外受精-胚胎移植(IVF-ET)过程中,虽然移植的胚胎不经输卵管而是直接进入宫腔,但术后HP发生率明显高于自然妊娠。     

复合妊娠诊治中国专家共识（2022年版）

复合妊娠（heterotopic pregnancy,HP）指宫内妊娠合并异位妊娠 ［1］。HP的自然发生率较低,随着辅助生殖技术的广泛应用,其发病率呈明显上升趋势。由于存在多部位妊娠,临床上HP易出现漏诊、误诊。有意愿继续维持宫内妊娠者,尤其辅助生殖技术助孕患者,其胚胎珍贵,HP的处理较为棘手,易出现宫内妊娠丢失、子宫外妊娠破裂出血,甚至危及生命。     

体外受精-胚胎移植后宫内妊娠合并子宫瘢痕妊娠一例

报道1例体外受精-胚胎移植(IVF-ET)后宫内妊娠合并子宫瘢痕妊娠(CSP)的病例。该患者取卵3枚,成功配成3枚胚胎,移植胚胎3枚,成功着床2枚,但1枚在宫内正常位置上,1枚着床在前次剖宫产切口上。该患者对瘢痕处的妊娠囊行减胎术后,因持续不规则阴道出血来医院就诊,妇科超声检查提示,宫腔内可见2个胎囊,其一可见胎芽,胎心(+),其二位于前次剖宫产切口处,仅见胎囊,其内未见卵黄囊及胎芽,形态不规则。最终行经腹宫腔内胎盘胎儿清除术+CSP病灶切除术+剖宫产瘢痕憩室修补术,终止妊娠。报道此特殊病例,将CSP的超声和磁共振成像(MRI)诊断技术的优缺点进行比较,并对CSP的治疗和预防提出一些思考。     

体外受精-胚胎移植术后复合妊娠研究进展

复合妊娠（heterotopic pregnancy,HP）是一种极其危险的异位妊娠,自然受孕者中HP的发生率并不高,但随着近年体外受精-胚胎移植（in vitro fertilization and embryo transfer,IVF-ET）术以及促排卵技术的普及,HP的发生率较前有所上升。HP患者早期一般仅有腹痛、阴道出血等非特异性症状,且由于宫内妊娠囊的存在使得宫外妊娠囊特别容易误诊和漏诊,从而易导致患者宫外妊娠囊继续发展,引起腹腔内大出血甚至休克等危及生命的严重后果。因此,充分了解HP的相关危险因素,在行ET术或促排卵技术前采取相应的预防HP发生的措施、发生HP后尽早进行确诊及确诊后采取有效的治疗对改善患者的预后显得尤为重要。综述近年IVF-ET后HP的诊断及管理措施进展。     

体外受精-胚胎移植后宫内妊娠合并子宫切口妊娠1例治疗分析

目的:探讨在宫内合并子宫下段切口瘢痕妊娠(cesarean scar pregnancy,CSP)复合妊娠时治疗CSP同时保存宫内胎儿安全有效的方法。方法:在本中心行体外受精-胚胎移植(IVF-ET)助孕后妊娠患者1例,经反复阴道超声检查确诊宫内合并CSP。在患者充分知情同意的前提下,于移植后35 d行阴道超声引导下经阴道CSP胚胎穿刺减灭术,术后保胎及定期产检。结果:孕37周出现宫缩后急诊剖宫产一活婴,发育正常,术中下段切口处出血多,但宫缩正常,术程共出血1 000 ml,切口缝合后出血止,保留子宫,术后42 d复查子宫复旧好。结论:IVF-ET后出现剖宫产CSP合并宫内妊娠的复合妊娠极为罕见,早期诊断后通过阴道针刺抽吸妊娠胚囊可以达到终止切口瘢痕妊娠的目的,而且对宫内正常的妊娠囊无任何影响,是在保存宫内妊娠的同时治疗CSP切实有效的方法。     

子宫颈妊娠的诊断及治疗

子宫颈妊娠是指孕卵在子宫颈管内(即组织学内口以下的宫颈内膜)着床和发育,是一种罕见而危险的异位妊娠。近年来,发病有上升趋势。国内零星报道多见于近十年内。子宫颈妊娠的病因尚不清楚,其发病上升的原因,可能与人工流产、中期引产,剖宫产及宫内节育器增多,干扰孕卵的正常着床有关。宫颈妊娠常发生难以控制的大流血、休克、感染及贫血,严重威胁患者的生命和健康。尽管近年来诊断及治疗有历改善,但仍属危险病症。由于宫颈妊娠较罕见,与以阴道出血为主的其它妇科疾病有时不易鉴别,因而易误诊及延误治疗。因此,提高对本病临床特点的认识很有必要。临床表现:①多见于经孕妇、有流产或/及有宫腔操作史。②有停经史及早孕现象,妊娠试验阳性。③阴道出血有以下特点:a.妊娠早期阴道无痛性出     

子宫下段瘢痕处妊娠误诊致大出血2例报道

剖宫产术后子宫瘢痕妊娠是罕见且危险的异位妊娠,其病因尚未完全明确.子宫瘢痕处妊娠与宫内早孕、先兆流产、滋养细胞肿瘤、宫颈妊娠临床表现相似,易误诊.此处妊娠一旦盲目行宫腔操作可致大出血,危及患者生命.现将2005年至2007年我院收治的子宫下段瘢痕处妊娠误诊致大出血2例报告如下.     

持续性不明部位妊娠一例并文献复习

不明部位妊娠是一种妊娠状态,有多种临床结局,如宫内妊娠、异位妊娠、流产型不明部位妊娠和持续性不明部位妊娠。持续性不明部位妊娠是不明部位妊娠较少见的一种临床结局,因其临床表现缺乏特异性,且找不到妊娠囊位置,诊断困难,容易误诊,在临床上如果治疗不及时,可导致妊娠囊破裂或妊娠部位的出血、坏死,可危及患者生命。在临床中通常需要结合定期连续监测的血人绒毛膜促性腺激素（hCG）值、孕酮值和阴道超声结果进行诊断及治疗。为了总结临床持续性不明部位妊娠诊治体会,进一步提高对持续性不明部位妊娠诊断治疗水平,报道1例罕见的持续性不明部位妊娠临床资料,结合持续性不明部位妊娠诊断和治疗进展进行文献复习。     

Cervical pregnancy treated with transvaginal ultrasound-guided intra-amniotic instillation of methotrexate

Aim Aim of the study was to investigate the efficacy of single transvaginal ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy with concurrent review of the literature.Materials and methods Six patients with cervical pregnancy are included in the study. All patients were treated with single transvaginal ultrasound-guided intraamniotic installation of 70 mg of methotrexate plus folic acid p.o. The main presenting symptoms were mild to moderate vaginal bleeding and lower abdominal cramp-like pain, resembling the clinical presentation of a threatened abortion. The typical ultrasound findings were the absence of intrauterine gestational sac and the detection of a gestational sac within the cervical canal, invading the anterior or the posterior wall of the cervix and normal appearance of the adnexa, bilaterally. The hourglass-shaped cervix was not characteristic at 5 weeks of gestation but it was at 8 weeks of gestation.Discussion Ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy appears to be an effective and safe method but the choice of the method should be depended on the gestational age of cervical pregnancy, the presence of active bleeding or not and its severity, the desire for preservation of future fertility, the presence of coexisting valuable intrauterine pregnancy and the experience of the physician in charge.     

A case of a cornual heterotopic pregnancy laparoscopically treated with the endoloop technique

Heterotopic pregnancy is defined as the coexistence of an intrauterine and an ectopic pregnancy. The estimated incidence is one in 30,000 spontaneous pregnancies, with a tenfold increase in women who underwent assisted reproductive technologies. Diagnosis of a heterotopic pregnancy is often delayed because of the presence of the intrauterine gestational sac. Treatment of a heterotopic pregnancy should consist of termination of the ectopic pregnancy without damaging the ongoing intrauterine pregnancy. The least invasive procedure should therefore be used. We present a case of a heterotopic pregnancy consisting of a viable intrauterine pregnancy and an ectopic cornual pregnancy. Because of the viable intrauterine pregnancy, we decided to treat the cornual pregnancy laparoscopically by the endoloop technique. This technique is simple, safe, effective and nearly bloodless. It offers a good prognosis for the ongoing intrauterine pregnancy.     

胎盘植入临床分析——附11例报告

目的:探讨胎盘植入病例的特点和治疗方法。方法:回顾性分析1999.03-2009.04收治11例胎盘植入病例资料。结果:3例早期妊娠胎盘植入均有剖宫产手术史,停经后有不规则阴道流血史;其中1例早期妊娠胎盘植入虽经超声提示孕囊位于子宫下段但仍误诊行人工流产及清宫手术时大出血;3例晚期妊娠分娩人工剥离胎盘时表明胎盘与子宫壁无间隙,经手术后病理证实胎盘植入;4例中期妊娠清宫时牵拉组织物有阻力,经彩色多普勒超声检查明确诊断;1例中期妊娠剖宫取胎时示胎盘与子宫壁无间隙,经手术后病理证实胎盘植入;3例早期妊娠者通过彩色多普勒超声检查确诊。早期处理的2例均手术切除子宫,近5年的9例行保守性手术和/或药物保守治疗成功保留患者生育功能。结论:对有剖宫产手术史患者停经后阴道流血就诊时,有必要行彩色多普勒超声检查;彩色多普勒超声检查有助于诊断胎盘植入;保守性手术和保守治疗可有效地避免子宫切除;严格剖宫产指征及重视避孕可预防胎盘植入的发生。     

Methotrexate in local treatment of cervical heterotopic pregnancy with successful perinatal outcome: case report

This case report describes a case of heterotopic cervical ectopic pregnancy in a nulliparous woman that was successfully treated with single-dose local, intra-amniotic methotrexate injection in the gestational sac. Pregnancy was achieved spontaneously. The patient had previously undergone hysteroscopic myomectomy. By using local, single-dose treatment we avoided the continued effects of the drug on the intrauterine pregnancy and the possible adverse effect of systemically applied methotrexate. The treatment resulted in the term vaginal delivery of a healthy child and preserved the patient's fertility for future pregnancies.     

Twin pregnancy (intrauterine and cervical) after hemihysterectomy: case reports

This case report describes a twin pregnancy in a hemihysterectomized patient who had a pyhemocervix present in 1/2 of a double uterus. An ultrasonic scan of this 29-year-old patient presenting with a history of 12 weeks amenorrhea revealed a retroverted uterus which contained a single fetus and a placenta situated on the anterior uterine wall. 1 week later, she was admitted with painless vaginal bleeding, and 6 days later aborted a complete gestational sac which contained a female fetus. 2 days later a large cystic mass, the size of a 3-month pregnancy, was incised and found to house an ectopic pregnancy. This is believed to be the 1st report of a combined intrauterine and cervical pregnancy following a hemihysterectomy.     

异位妊娠48例误诊临床分析

目的探讨异位妊娠误诊的原因，提高异位妊娠早期诊断。方法对1989年1月～2004年11月在我院收治的异位妊娠178例中48例异位妊娠误诊做回顾性分析，寻找导致误诊的因素。结果48例病例中，误诊为宫内早期妊娠23例，先兆流产3例，盆腔炎2例，子宫内膜炎2例，黄体破裂、卵巢囊肿扭转各1例，急性阑尾炎6例，胆囊炎1例，急性胃肠炎9例。结论内外科对育龄妇女的急腹症勿忘询问停经史和不规则阴道流血史；妇产科急腹症和早孕疑似病例重视虮、尿HCG和阴道B超检测综合分析是降低异位妊娠漏诊率和误诊率的关键。     

Rare presentation of ectopic pregnancy following IVF-ET: live twin gestation in the same fallopian tube

We report a case of a twin ectopic pregnancy (EP) after in vitro fertilization and embryo transfer (IVF-ET). A 24-year-old nulligravida presented with lower abdominal pain and vaginal bleeding 4 weeks after embryo transfer. Serum β-HCG levels were 40 IU/mL, 90 IU/mL, and 1970 IU/mL on ET days 12, 14, and 23, respectively. Ultrasound examination revealed two ectopic gestational sacs with fetal heart beats in the left adnexa, without evidence of intrauterine pregnancy. At laparoscopy, one isthmic and another ampullary sac were detected in the left tube and left salpingectomy was performed. The patient was discharged healthy on postoperative day 2. Albeit extremely rare, ectopic pregnancies with abnormal presentation can be encountered following IVF-ET. Single embryo transfer may be advised to protect from ectopic pregnancies after IVF-ET.     

Successful treatment of a cervical pregnancy with a single low dose methotrexate regimen

Until very recently cervical pregnancies have been treated with surgery, usually hysterectomy. The development of endovaginal ultrasound, which allows early diagnosis, and methotrexate chemotherapy have opened up new therapeutic options. A 45-year-old multigravida presented at 8 weeks' gestation with vaginal bleeding. Endovaginal ultrasound demonstrated a cervical pregnancy with a fetal pole, 1.2 × 1.4 cm sac, no cardiac pulsations, and an empty uterus. After discussion with the patient, single low dose methotrexate 1.5 mg/m² was given intramuscularly. The patient's hCG titre was 5882 IU-(Third International Standard). Over a 5-week period the hCG titres fell, and the gestational sac disappeared. The patient experienced intermittent vaginal bleeding and cramping but was managed as an outpatient. Single low dose methotrexate may be a successful management option in selected cases of cervical pregnancy.