剖宫产瘢痕妊娠经阴道超声图像特征分析

目的:探讨剖宫产瘢痕妊娠(CSP)的阴道超声表现。方法:回顾性分析298例CSP经阴道超声的图像,观察妊娠物的位置、回声及与子宫切口的关系及子宫切口部位的厚度、血流情况。结果:298例CSP根据声像图特征分为2型:孕囊型(182例)和流产型(116例)。结论:CSP由于病史不同声像图各具特征性表现,经阴道超声对CSP的诊断有重要的价值。     

交通性残角子宫合并妊娠误诊2例分析

残角子宫妊娠是指受精卵着床和发育于残角子宫的一种异位妊娠。它可引起严重的腹腔内大出血，由于该病发病率较低，容易引起误诊。交通性残角子宫妊娠则更为罕见，国内仅有散在的病例报告。武汉大学人民医院和荆门第一人民医院于2000．09-2006．06共收治残角子宫合并妊娠误诊患者2例，对临床表现、治疗和预后进行了回顾性分析。     

输卵管以外部位异位妊娠15例临床分析

输卵管以外部位异位妊娠１５例临床分析谷素贞杨静输卵管以外部位异位妊娠包括：子宫颈、子宫角、残角子宫、卵巢、腹腔等部位的妊娠。部位特殊极易误诊。我院１９８６～１９９６年共诊治１５例，均经病理检查证实，现报告分析如下。一、临床资料（一）一般资料１．部位及...     

44例特殊部位妊娠的介入检查分析

目的:探讨血管介入治疗少见类型异位妊娠的方法、临床疗效及其适应症。方法:术前造影确定异位妊娠所在部位及供血动脉,采用经股动脉穿刺、超选择双侧子宫动脉或患侧卵巢动脉灌注MTX及栓塞明胶海绵的方法对44例异位妊娠患者行放射性血管介入治疗,其中宫角妊娠6例,宫颈妊娠18例,疤痕子宫切口部位妊娠6例,输卵管间质部妊娠5例,残角子宫妊娠5例以及卵巢妊娠4例。术前、术后观察患者临床症状、体征、血β-HCG值、肿块大小及阴道流血情况。结果:44例患者中,43例获得一次性成功,治愈率97.72%;1例卵巢妊娠介入治疗失败,改行手术治疗(患侧卵巢楔形切除术)。结论:放射性血管介入治疗少见类型异位妊娠安全、可靠、简便、易行,疗效显著,无特殊禁忌症,对有生育要求者更为适应,值得推广。     

残角子宫妊娠7例临床分析

残角子宫妊娠是极为罕见的一种异位妊娠,误诊率很高,常因不能及时诊断、延误手术而造成破裂出血,甚至危及生命,现将20余年我们诊治的7例残角子宫妊娠病例分析总结如下。     

残角子宫妊娠的临床特点(附6例报道)

残角子宫妊娠是一种罕见的异位妊娠，如果发生破裂，可致腹腔内血，严重者可危及生命，术前很少有明确诊断者，容易误诊误治。     

剖宫产后瘢痕处妊娠经阴道超声图像分析的临床意义

目的:探讨剖宫产后瘢痕处妊娠超声图像特点及其对临床处理的指导意义.方法:回顾性分析经阴道超声检查诊断为瘢痕处妊娠的40例患者的超声图像及其对应的临床处理资料.结果:①40例患者经二维阴道超声检查均明确诊断,超声图像表现为孕囊型6例、空泡型9例、团块型25例;CDFI表现为血流信号丰富15例、有血流信号20例、无血流信号5例,其中血流信号丰富患者的CDFI频谱多为高速低阻,占87%(阻力指数RI＜0.5).②根据团块或孕囊与肌层的关系分为4级.其中0级5例,均选择保守治疗全部成功;1级18例,行保守治疗成功17例,1例行子宫病灶切除术加子宫修补术;2级13例,11例行保守治疗成功,1例行子宫切除术,1例行子宫修补术;3级4例,3例行子宫切除术,1例行子宫修补术.结论:掌握阴道超声检查剖宫产后瘢痕处妊娠声像图特点,为正确诊断瘢痕处妊娠提供了依据.根据声像图中孕囊或团块与肌层的关系进行分级,并结合彩色血流检查结果,有利于指导选择合适的临床处理方案.     

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32例临床分析

残角子宫妊娠是指受精卵着床和发育于残角子宫的一种异位妊娠。它可引起严重的腹腔内大出血，由于该病发病率较低，容易引起误诊。我们通过回顾性分析22年来在本院手术的32例残角子宫妊娠患者的临床特点，以期提高临床医生对该病的认识。现报道如下。     

特殊部位异位妊娠的分析及进展

异位妊娠是妇科常见急腹症之一,随着妇科炎症、性传播疾病、宫腔操作和剖宫产率的不断攀升,特殊部位异位妊娠的发病率也在逐年增加.特殊部位异位妊娠包括子宫瘢痕、卵巢、残角子宫、子宫颈及腹腔等少见部位的异位妊娠.临床表现缺乏特异性、体征不典型,故早期诊断困难,极易误诊,严重威胁患者的生命.随着专科医生对异位妊娠的警惕性不断提高,超声对异位妊娠诊断依据的不断规范及患者对优生优育知识认知的不断深入,特殊部位异位妊娠给患者造成的威胁也在逐年减少.特殊部位异位妊娠除有停经、腹痛、阴道出血三大临床表现外,还各有特点.重视其临床表现及各自特点,早期诊断、及时治疗是妇产科临床医生及全科医院急症科医生面对的重要课题.     

各孕周宫角妊娠38例临床分析

目的 探讨各孕周宫角妊娠的临床特点、诊断和治疗方法.方法 对2006年1月至2010年8月郑州大学第一附属医院收治的38例宫角妊娠的患者进行回顾性的分析.结果 38例宫角妊娠的患者中,停经38例(100%)、不规则阴道出血27例(71.1%)和腹痛22例(57.9%).宫角妊娠术前诊断困难,误诊率近50%.38例患者中...     

Sub-hepatic ectopic pregnancy in a fallopian tube of a non-communicating rudimentary uterine horn

Ectopic pregnancy in a non-communicating rudimentary uterine horn is a rare occurrence. The authors describe a case of ectopic pregnancy in a fallopian tube of a non-communicating uterine horn. The unusually high position of the ectopic gestation into the sub-hepatic region affects the early clinical presentation. The patient had been treated successfully by laparoscopic salpingectomy.     

Chronic abdominal pregnancy following rupture from a bicornuate uterus

The authors report a rare occurrence of a chronic abdominal pregnancy secondary to a ruptured bicornuate uterus. It is unusual in that rupture of the uterine horn probably occurred 2 weeks prior to diagnosis. Management was laparotomy to remove the fetus with resection and repair of the uterus. Uterine anomalies, their imaging and diagnosis, as well as the patient’s subsequent reproductive prognosis are discussed.     

Case of live birth in a non-communicating rudimentary horn pregnancy

Pregnancy in the rudimentary horn is an extremely rare condition. This report describes an unusual pregnancy in the rudimentary horn, which was misdiagnosed as a bicornuate uterine pregnancy on early obstetric sonogram. The pregnancy was successfully delivered using cesarean section, with both neonatal and maternal survival.     

Do low-risk nulliparous women with abnormal uterine artery Doppler in the third trimester have poorer perinatal outcomes? A longitudinal prospective study on uterine artery Doppler in low-risk nulliparous women and correlation with pregnancy outcomes

Objective: To evaluate uterine artery (UtA) Doppler over the course of pregnancy in low-risk nulliparous women and to analyze whether an abnormal uterine artery pulsatility index (UtA-PI) at a 32–34 week’ scan implies poorer perinatal outcomes.

Methods: An observational prospective study was carried out including 616 low-risk nulliparous women. Women with any of the following were excluded: fetal abnormalities, multiple pregnancy, and heparin, metformin or hypotensive treatment. Maternal characteristics, mean arterial pressure measurements and UtA Doppler findings were recorded longitudinally.

Results: Complete pregnancy data were available for 489/616 women (79.3%). Of these, 385 women had a normal UtA-PI throughout pregnancy (Group 0), while 50 (10.1%) had an UtA-PI?>?95th percentile in the first or the second trimester that normalized in the third trimester (Group 1), and 56 (11.4%) had an abnormal UtA-PI in the third trimester (Group 2). We found that the rate of pre-eclampsia (PE) was higher in Group 2 (7/56 versus 4/435, p?=?0.003) as was the rate of intrauterine growth restriction (IUGR) (6/56 versus 14/435, p?=?0.02).

Conclusions: Low-risk nulliparous women with abnormal UtA Doppler findings in the third trimester are at a higher risk of developing PE and having a baby with IUGR.     

Pregnancy in a non-communicating rudimentary horn: a cause of failed medical and surgical management of second trimester pregnancy loss

Objectives: We present the management of a case of failed medical and surgical management of second trimester pregnancy loss due to pregnancy in a non-communicating rudimentary horn.

Case: A 16-week intrauterine fetal death singleton pregnancy was referred to us after failed medical and surgical termination of pregnancy. Ultrasound confirmed the diagnosis and showed minimal blood clots and fluid in the pouch of Douglas. Laparoscopy showed a soft, enlarged right uterine horn not communicating with the cervix and containing the pregnancy, and a left uterine horn communicating with the cervix and showing a posterior wall perforation. The procedure was converted to laparotomy, and the right uterine horn and adjacent tube were excised. The patient made an uneventful recovery and was discharged after 3 days.

Conclusion: Pregnancy in a non-communicating horn is rare and usually presents with serious complications. Any case of failed medical termination of pregnancy after repeated doses of misoprostol should be carefully assessed to exclude the possibility of uterine anomalies (especially in a primigravida), before proceeding with dilatation and evacuation to minimise the risk of complications.     

子宫肌壁间妊娠的临床分析

目的:探讨子宫肌壁间妊娠(intramural pregnancy,IMP)的临床表现、发病相关因素、鉴别诊断及诊疗手段。方法:回顾分析4例IMP患者的既往盆腔手术病史、临床表现、辅助检查、诊疗经过及病理结果,探讨IMP发病因素、鉴别和诊治手段。结果:4例均为宫角肌壁间妊娠(包块型)。超声及磁共振成像(MRI)误诊为宫角妊娠以及滋养细胞肿瘤不除外。4例均行宫腹腔镜联合探查术,治疗后随访血人绒毛膜促性腺激素(hCG)均降至正常范围。结论:临床上对于清宫不成功,清宫后血hCG持续不降并伴阴道出血,而超声、MRI等辅助检查提示子宫肌层占位且血流信号丰富的患者应高度警惕IMP,尽早诊治。     

Colour Doppler Imaging of the Uteroplacental Circulation in the Mid-Trimester: Features of the Uterine Artery Flow-Velocity Waveform that Predict Abnormal Pregnancy Outcome

EDITORIAL COMMENT: We accepted this paper for publication because it presents data on the use of colour Doppler imaging in a screening test in healthy nulliparas to assess whether abnormal pregnancy outcome can be identified. Unexpectedly there were 4 perinatal deaths in this series and table 4 indicates that in the only case in which the perinatal death was potentially avoidable the 24-week uterine Doppler studies were normal. There is mounting evidence that Doppler imaging of uteroplacental circulation is useful in the management of identified high-risk pregnancies but the value of the method as a screening test remains unproven. If larger studies confirm the reliability of this investigation to detect patients who are destined to develop preeclampsia then a possible application of this is identification of women who warrant prophylactic aspirin therapy since recent results show that aspirin therapy is not indicated routinely in nulliparas
Summary: The accuracy of raised Resistance Index (RI) and early diastolic notching (EDN) of mid-trimester uterine artery flow velocity waveforms in predicting abnormal pregnancy outcome was assessed in a prospective longitudinal study using colour Doppler imaging at 14, 18, and 24 weeks. In 106 healthy nulliparas with a singleton pregnancy studied; 70 had a normal pregnancy outcome, 34 had an abnormal pregnancy outcome, and 2 were lost to follow-up. EDN was more sensitive than raised RI at predicting subsequent abnormal pregnancy outcome but raised RI was more specific at 14 and 18 weeks. Sensitivities were highest for the pregnancies with the more severely abnormal outcomes. Uterine artery Doppler studies in the mid-trimester can predict abnormal pregnancy outcome. The presence of an early diastolic notch is an important feature when defining an abnormal or high resisitance uteroplacental circulation.     

Pregnancy and Placenta Increta in a Noncommunicating Uterine Horn

BackgroundWe present a rare case of pregnancy and invasive placentation in a unruptured, noncommunicating rudimentary uterine horn at 20 weeks’ gestation.CaseThe patient was followed with ultrasound throughout early pregnancy and initial imaging for dating purposes showed a pregnancy within a communicating right horn of the uterus. At the 18-week anatomy ultrasound, the pregnancy was discovered to be within the noncommunicating, rudimentary left horn of the uterus. This was confirmed using pelvic magnetic resonance imaging. The patient opted for surgical management and subsequently underwent laparotomy and removal of the noncommunicating uterine horn and pregnancy. Placental tissue was adherent to the level of the serosa during surgery and pathologic diagnosis was significant for a placenta increta.Summary and ConclusionThe patient recovered well from surgery and subsequently went on to have a successful term pregnancy delivered via cesarean section for breech in the right horn 15 months later.     

Tale of rudimentary horn pregnancy: case reports and literature review

Rudimentary horn pregnancy (RHP) is a rare form of pregnancy in a rudimentary uterine horn with a reported incidence of 1 in 76,000 and 1 in 150,000. A significant number of cases is diagnosed only following rupture of the RHP with an estimated maternal mortality rate of 0.5%. Early diagnosis can help in planning management before its rupture and allows for surgical treatment using laparoscopy.