宫内宫颈复合妊娠一例

复合妊娠发病率低，临床表现缺乏特异性，与普通异位妊娠一样，可伴有腹痛、阴道不规则出血等，有的患者甚至没有任何症状，而且由于宫内妊娠囊的存在，易忽略异位妊娠囊，因此早期诊断困难，常误诊为早期流产。回顾重庆市妇幼保健院（我院）近5年移植周期数据（共41 596个移植周期），仅2020年收治1例宫内妊娠合并宫颈妊娠患者。该患者既往有多次宫腔操作史，并多次行宫腔粘连分离术，新鲜周期因子宫内膜薄而取消移植，后来院行冻融胚胎移植助孕，解冻并移植卵裂期胚胎2枚，患者因移植术后反复阴道不规则出血就诊，早期急诊以“先兆流产”收入院行保胎治疗，后B超证实系宫内宫颈复合妊娠，患者保留宫内妊娠意愿强烈，遂行减胎术保守治疗（2次减胎术），最终分娩1女活婴。本病例提示复合妊娠易漏诊和误诊，应尽早明确诊断，如病情稳定、孕周小，减胎术是一种有效的治疗手段。

A Case of Heterotopic Cervical Pregnancy

The incidence of heterotopic pregnancy（HP） is low and the clinical manifestations is lack of specificity. It can be accompanied with abdominal pain, irregular vaginal bleeding and so on, as common ectopic pregnancy. Some patients do not even have any symptoms, and due to the existence of the sac of intrauterine pregnancy, it is easy to ignore the ectopic gestational sac, so the early diagnosis is difficult, often misdiagnosed as early abortion. Review the data of the transplant cycle in our center in the past 5 years, included 41 596 transfered cycles, only 1 heterotopic cervical pregnancy patient was admitted in 2020. The patient had multiple uterine cavity operations in the past and underwent multiple intrauterine adhesions separation. The fresh cycle was cancelled due to thin endometrium. Later, we performed frozen-thawed embryo transfer，thawed and transferred 2 cleavage-stage embryos. Due to repeated irregular vaginal bleeding after transplantation, the patient was admitted to the hospital as a "threatened abortion" in the early emergency department for fetal protection treatment. Later, B-ultrasound confirmed that it was a heterotopic cervical pregnancy. The patient had a strong desire to retain the intrauterine pregnancy, and underwent conservative treatment of fetal reduction (twice), and finally delivered a child. It is suggested that the complex pregnancy is easy to be missed and misdiagnosed, and the diagnosis should be made as early as possible. If the condition is stable and the gestational age is small, fetal reduction surgery can be regarded as an effective treatment.