Delayed ectopic pregnancies after sterilization

Female sterilization as an interval, postabortal or postpartum procedure, is one of the most widely employed contraceptive techniques on a global basis. The short-term complications of sterilization, which include intra- and extrauterine pregnancies, are well researched and documented. The figures for long-term complications, including ectopic pregnancy, are much less reliable as the follow-up rates diminish as time passes after sterilization. Three cases of tubal pregnancy that occurred long after interval sterilization are presented as a warning against the assumption that long-term complications cannot occur.     

A case of seven recurrent ectopic pregnancies

If a woman with previous ectopic pregnancy ever gets pregnant again, the risk of a repeat ectopic pregnancy is said to be 4-fold. We present a rare case of 7 recurrent ectopic pregnancies in a 39-year-old Saudi woman, together with a literature review of the reproductive performance after recurrent ectopic pregnancy.     

35例特殊部位异位妊娠临床分析

目的：探讨特殊部位异位妊娠的临床特征及误诊原因,降低误诊率。方法;对35例特殊部位异位妊娠进行回顾性分析。结果：其发生率占同期异位妊娠的9.04%,误诊率80％。输卵管间质部妊娠易引起致命性腹腔出血、宫角妊娠子宫不对称性增大,腹腔妊娠孕早期一过性下腹痛,卵巢妊娠术前不易确诊,宫颈妊娠以无痛性阴道反复流血为主要临床表现。结论：提高对特殊部位异位妊娠的认识、详询病史,重视临床表现,结合β-HCG、B超及腹腔镜等综合分析、避免误诊。     

少见部位异位妊娠31例临床分析

目的：探讨少见部位异位妊娠的临床特征及误诊原因。方法：对2001年2月～2011年2月我院收治的31例少见部位异位妊娠进行回顾性分析。结果：少见部位异位妊娠占同期异位妊娠的6.39%,误诊率为74.2%。除宫颈妊娠及宫角妊娠保守治疗成功者外,均需手术探查。结论：少见部位异位妊娠早期诊断较困难,对疑诊病例应及早清除病灶或手术探查,治疗效果好。     

重复异位妊娠的高危因素分析

目的:探讨重复异位妊娠发生的高危因素。方法:1 560例异位妊娠保守治疗患者,成功随访有生育要求的360例患者,追踪生育结局。结果:重复异位妊娠的发生率为25.8%,其中前次异位妊娠治疗方法为经腹腔镜手术发生率为18.3%,经开腹手术为45.1%,药物保守治疗为31.7%,差异有统计学意义(P0.01)。72例术中发现盆腔粘连,重复异位妊娠54.8%发生在同侧输卵管,45.2%发生在对侧输卵管。结论:重复异位妊娠的发生主要与盆腔炎症及前次异位妊娠的治疗方法有关。加强健康教育,积极防治盆腔炎性疾病,选择腹腔镜手术是预防重复异位妊娠发生的重要手段。     

特殊部位异位妊娠26例临床分析

目的探讨特殊部位异位妊娠的临床特征及误诊原因。方法回顾26例特殊部位异位妊娠的临床资料。结果特殊部位妊娠发生率占同期收治异位妊娠的6.03%,误诊率52.69%。宫角妊娠子宫不对称性增大,宫颈妊娠以无痛性反复阴道出血为主要特征,忽略了瘢痕妊娠行人工流产时可发生致命大出血,卵巢妊娠术前不易确诊。结论特殊部位异位妊娠因其妊娠部位不同,临床表现不典型,应详询病史,仔细查体,结合-βHCG、B超等进行综合分析,以避免误诊。     

先天性鱼鳞病的少见临床类型

目的总结先天性鱼鳞病少见临床类型的特征和治疗方法。方法分析2005年5月~2006年8月我院收治的少见类型的先天性鱼鳞病患儿4例。结果4例均否认有家族性遗传性疾病史。2例非大疱性先天性鱼鳞病样红皮病,表现为红皮病和弥漫性白色至淡棕色鳞屑,均发生睑外翻和听力异常,其中1例掌跖角化过度。2例表皮松解性角化过度鱼鳞病于出生后不久起水疱,以后增厚灰棕色的、疣状鳞屑泛发于躯干和四肢,包括皱襞部。2例均发生红皮病,掌跖未累及,指趾甲和毛发正常。本组4例患儿经治疗后改善,其中3例应用阿维A联合外用药物治疗。结论2例表皮松解性角化过度鱼鳞病可能由自发突变引起。小剂量阿维A联合外用药物治疗先天性鱼鳞病安全但短期有效。     

先天性鱼鳞病的少见临床类型

目的 总结先天性鱼鳞病少见临床类型的特征和治疗方法.方法 分析2005年5月～2006年8月我院收治的少见类型的先天性鱼鳞病患儿4例.结果 4例均否认有家族性遗传性疾病史.2例非大疱性先天性鱼鳞病样红皮病,表现为红皮病和弥漫性白色至淡棕色鳞屑,均发生睑外翻和听力异常,其中1例掌跖角化过度.2例表皮松解性角化过度鱼鳞病于出生后不久起水疱,以后增厚灰棕色的、疣状鳞屑泛发于躯干和四肢,包括皱襞部.2例均发生红皮病,掌跖未累及,指趾甲和毛发正常.本组4例患儿经治疗后改善,其中3例应用阿维A联合外用药物治疗.结论 2例表皮松解性角化过度鱼鳞病可能由自发突变引起.小剂量阿维A联合外用药物治疗先天性鱼鳞病安全但短期有效.     

氨甲喋呤治疗输卵管妊娠疗效因素分析

目的 :分析影响氨甲喋呤 (MTX)治疗输卵管妊娠的疗效因素。方法 :前瞻性研究 15 2例输卵管妊娠且无腹腔内出血并发症患者。分析MTX的疗效因素。结果 :共有 15 2例输卵管妊娠患者 ,MTX治疗成功 12 6例 ,有效率 83% ,治疗失败 2 6例 ,无效率 17%。治疗成功组 :胎心存在数 10例、β -hCG3785± 2 382mIU/ml、孕酮 7.4± 6 .5mg/ml,失败组 :胎心存在数 16例 ,β -hCG14 2 32±82 34mIU/ml,孕酮 13.7± 7.5ng/ml,相对应的各数组有显著差异。回归分析显示胎心和 β -hCG影响MTX治疗成败的二个主要因素。结论 :对无腹腔内出血的输卵管妊娠的患者 ,胎心的存在和高β -hCG是导致MTX治疗失败的二个主要因素。MTX的保守治疗应选择无胎心而 β -hCG <5 0 0 0IU/ml或有胎心而β -hCG <2 0 0 0IU/ml的患者     

彩色多普勒超声诊断剖宫产术后子宫瘢痕妊娠的价值

目的探讨彩色多普勒超声在诊断剖宫产后子宫瘢痕妊娠的价值。方法分析11例经彩超诊断的剖宫产后子宫瘢痕妊娠的资料,分析其超声图像特征。结果剖宫产后子宫瘢痕妊娠有孕囊型及包块型两种类型。结论超声检查是剖宫产后子宫瘢痕妊娠的首选方法。     

95例输卵管妊娠的阴道超声图像分析及临床意义

孕卵在宫腔以外地方着床称为异位妊娠 ,习称宫外孕。因孕卵种植位置不同 ,可分为输卵管妊娠、卵巢妊娠、腹腔妊娠、宫颈妊娠、间质部妊娠、残角妊娠等。其中以输卵管妊娠最为多见 ,约占异位妊娠的95 %以上[1] 。输卵管妊娠的早期诊断 ,是指孕卵在输卵管未破裂前或早期流产破损所作出的诊断。本文通过对 95例输卵管妊娠的阴道超声图像进行分析 ,以探讨阴道超声对输卵管妊娠早期诊断及治疗的临床意义。1　资料与方法资料来源于 1999年 6月～ 2 0 0 2年 5月间经阴道超声诊断为输卵管妊娠 ,并在我院住院治疗的 95例病人。其中临床首诊为宫外孕的…     

食管胃黏膜异位病理诊断分型与临床症状的关系

目的探讨食管胃黏膜异位病理分型与患者临床表现之间的关系,为食管胃黏膜异位的治疗提供病理依据。方法收集2018年6月1日至2019年1月31日在深圳市第二人民医院行胃镜检查并诊断为食管胃黏膜异位的患者96例,胃镜观察包括白光观察及窄带光谱成像(NBI)。所有患者病变均位于食管上段,所有患者均在异位黏膜处活检,按照腺体不同分为胃底型、贲门型和胃窦型,胃底型经HE染色后在100倍视野下随机观察5个视野,明确是主细胞(>50%)为主型,还是壁细胞(>50%)为主型,将以上分型与患者临床表现进行比较研究。结果病变位于距门齿16～21 cm食管上段,形态为圆形或椭圆形,白光内镜下病变呈橘红色,NBI观察可见腺管构造及白区,病变最小者3 mm×4 mm,病变最大者20 mm×32 mm,其中单发61例,双发病灶27例,多发病灶8例,共有病灶140个,平坦型病灶124个,隆起型病灶16个,所有病灶均未合并局部溃疡或恶变;胃底型异位有72个,贲门型47个,胃窦型21个;胃底型食管胃黏膜异位患者的癔球症、咳嗽、声嘶及烧心症状发生率分别为72.22%、84.72%、58.33%、76.39%,贲...     

Misdiagnosis and Delayed Diagnosis for Ectopic and Heterotopic Pregnancies after In Vitro Fertilization and Embryo Transfer简

This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.     

Update on ectopic pregnancy.

Ectopic pregnancy is the leading cause of maternal death in the first trimester. Its incidence is increasing, probably owing to the increasing incidence of pelvic inflammatory disease. Although up to 15% of patients have been reported to present in shock, a large number seek care earlier because of pelvic pain and irregular menses. With strong clinical suspicion and the use of culdocentesis, assays of the beta subunit of human chorionic gonadotropin in the blood and ultrasonography, the diagnosis can be made before rupture occurs. Although the woman's subsequent fertility has traditionally been poor, some improvement has been achieved with the use of conservative surgical techniques. Early diagnosis facilitates this approach.