Primary twin ovarian pregnancy: case report and review of the literature

Primary twin ovarian pregnancy is extremely rare. We present one such case in a 25-year-old primigravida who complained of lower abdominal pain and mild vaginal bleeding at 8 weeks after her last menstrual period. Transvaginal sonography revealed an empty uterus and presence of a gestational sac containing 2 dead embryos in the right ovary. The patient underwent unilateral oophorectomy, and histologic studies confirmed a uniovular-diamniotic ovarian pregnancy. A brief review of the literature revealed that primary ovarian pregnancy may occur without any classical antecedent risk factors, and endovaginal sonography can be useful to establish early preoperative diagnosis of ectopic ovarian pregnancy.     

Rudimentary horn pregnancy: first-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging.

OBJECTIVE: Two cases of rudimentary horn pregnancy diagnosed in the first trimester by sonography and confirmed by magnetic resonance imaging (MRI) are reported. We suggest criteria for early, prerupture sonographic diagnosis of this rare condition. METHODS: We report a case in which pregnancy in a rudimentary horn was suspected on routine sonographic examination. In the second case, sonographic examination at 11 weeks' gestation revealed a right unicornuate uterus and a noncommunicating left rudimentary horn containing a gestational sac. In both cases, MRI clearly confirmed the sonographic diagnosis, showing an empty cavity of the uterine body and a pregnant uterine horn without an endometrial communication to the uterine body. RESULTS: Both patients underwent surgery, and the pregnant rudimentary horns were resected with no complications. CONCLUSIONS: We suggest the following criteria for sonographic diagnosis of rudimentary horn pregnancy: (1) a pseudopattern of a asymmetrical bicornuate uterus, (2) absent visual continuity tissue surrounding the gestational sac and the uterine cervix, and (3) the presence of myometrial tissue surrounding the gestational sac. Typical hypervascularization of placenta accreta may support the diagnosis. Additionally, MRI can be used to confirm the diagnosis before an invasive procedure is undertaken.     

The echoic pseudogestational sac of ectopic pregnancy simulating early intrauterine pregnancy

The sonographic features of ectopic pregnancy have been well documented. When an early intrauterine pregnancy is identified or an obvious extrauterine sac is visualized, diagnosis is not a problem; but often a sac is seen within the uterus that may contain a well-defined rind and even internal echoes simulating an early fetal pole. This has been mistaken for an early intrauterine pregnancy. In this review, four patients with pseudogestational sacs had internal echoes within the sac, and two of them ultimately underwent dilatation and curettage, which revealed blood clots. This supports the assertion that fetal cardiac activity and/or fetal motion should be demonstrated within a fetal pole before the diagnosis of ectopic pregnancy is excluded.     

二维及彩色多普勒超声对早期宫内外孕的鉴别诊断价值

目的 探讨二维超声及彩色多普勒超声（简称彩超）对早期宫内外孕的鉴别诊断价值。方法 采用二维超声检查,筛选,对可疑宫外孕早孕合并盆腔包块者及早孕二次复查不能确诊者加用彩超检查。用彩色能量图显示低速血流,用脉冲多普勒寻找高舒张期低阻力滋养动脉血流频谱。结果 135例中76．3％（71／93）的宫内孕可用二维超声诊断,64例加用彩超者,宫内孕或宫外孕包块可检测出滋养层动脉血流。而宫内“假孕囊”,内良性包块均显示不出滋养层动脉血流频谱。结论 彩超是目前诊断宫内外孕的最有价值的手段,其血流频谱的特征性具有鉴别诊断意义,而二维超声的经济实用性可作为早孕检查的首选。     

Ectopic uterine scar pregnancy: A case report

IntroductionImplantation of a gestational sac in a previous Caesarean section scar of the lower uterine segment is a rare form of ectopic pregnancy.Case reportWe report a case of Caesarean scar ectopic pregnancy in a 25-year-old female, diagnosed by ultrasonography and confirmed by magnetic resonance imaging. We present the clinical details, imaging findings, and management of the patient.DiscussionImaging plays an important role in the diagnosis of ectopic pregnancy and ultrasonography is the modality of choice. Ultrasonography features of scar ectopic pregnancy include empty uterus and cervix with normal endometrium and endocervical canal, gestational sac (with embryo and/or yolk sac) in the anterior part of the lower uterine segment in the region of the Caesarean scar with a thin myometrial layer between the bladder wall and gestational sac. Magnetic resonance imaging may be used as an adjunct imaging modality in cases with inconclusive or equivocal sonographic findings. Termination of pregnancy in the first trimester should be considered and treatment options should be individualized as there is no universal agreement on the best or most preferred treatment modality.ConclusionAwareness of specific ultrasound features of scar ectopic pregnancy is crucial for early recognition, correct diagnosis, and initiating prompt management to prevent complications.     

The sonographic features of intra-abdominal pregnancy

The sonographic features of three cases of extrauterine, intra-abdominal pregnancy are presented in conjunction with a brief review of the clinical and radiographic features of the condition. Based on our experience and a review of the literature, we found that the major criteria for the sonographic diagnosis of extrauterine, intra-abdominal pregnancy include: 1) demonstration of a fetus in a gestational sac outside the uterus, or the depiction of an abdominal or pelvic mass identifiable as the uterus separate from the fetus; 2) failure to see a uterine wall between the fetus and urinary bladder; 3) recognition of a close approximation of the fetus to the material abdominal wall; and 4) localization of the placenta outside the confines of the uterine cavity.     

子宫颈妊娠的声像图及临床资料分析

目的探讨超声在子宫颈妊娠诊断及临床应用中的价值。方法回顾性分析7例子宫颈妊娠患者的超声图像特征及其临床资料。结果7例子宫颈妊娠除1例在术后再次超声检查时确诊外,其余均为超声首次诊断。子宫颈妊娠图像特征:宫腔内未见妊娠囊,子宫颈内口关闭,子宫颈管内见不规则妊娠囊或回声紊乱区,彩色血流信号丰富。结论经阴道及腹部超声联合彩色多普勒超声诊断子宫颈妊娠准确率高,可为临床及时处理和早期保守治疗提供可靠的诊断依据,使患者保留生育功能,减少病死率。     

经阴道超声诊断异位妊娠的价值

目的探讨(早期)异位妊娠(EP)的经阴道超声(TVS)诊断应用价值.方法对146例不规则少量阴道流血(或)下腹痛的育龄妇女或停经后经腹B超(TAS)提示宫腔内未见孕囊者疑EP的均行TVS检查,观察宫内是否有孕囊,仔细寻找识别卵巢及肿块结构并分清其关系,必要时结合彩色多普勒,观察肿块血流成像,分晰其血流频谱.结果 TVS能很好地显示子宫、卵巢、未破孕囊及含血(块)肿块的声像结构.识别出完整的卵巢,是输卵管异位妊娠确诊的关键;彩色多普勒血流成像(CDFI)所记录的滋养层血流频谱或怪异频谱是二维TVS的补充,二者结合诊断EP的准确性高达97%.结论 TVS诊断EP简单、无创、准确性高,是诊断早期异位妊娠的首选方法.     

子宫部位异位妊娠临床分析

目的探讨子宫部位异位妊娠的临床特征和处理对策。方法回顾分析2002年9月-2009年9月间收治的31例子宫部位异位妊娠患者的临床资料。结果 31例患者中,初诊确诊仅8例,误诊率74.2%。除5例因难以控制的大出血行经腹病灶清除术加子宫修补术或全子宫切除术外,其余26例患者均经氨甲喋呤（MTX）治疗加清宫术或宫腔镜下病灶清除术保守治疗成功。结论子宫部位异位妊娠容易误诊,超声检查是诊断的主要方法。保守治疗安全、有效,可保留生育能力。氨甲喋呤治疗加清宫术可作为治疗子宫部位异位妊娠的主要方法。     

经阴道超声与经腹部超声诊断异位妊娠的比较

目的比较经阴道超声(TVS)与经腹超声(TAS)在异位妊娠诊断中的价值。方法对109例异位妊娠患者以双盲法分别进行经腹部和经阴道超声检查。结果子宫清晰显示率、子宫内膜测定率、盆腔肿块显示率、盆腔肿块清晰显示率、肿块内检出孕囊样结构及原始心管搏动率,以及肿块内彩色血流信号检出率,TVS均明显高于TAS。结论TVS比TAS诊断异位妊娠更准确。临床诊断疑为异位妊娠的患者,应首选进行TAS或TVS检查,有条件的医院应常规进行TVS检查。     

超声在剖宫产切口瘢痕妊娠早期诊断及介入治疗中的应用

目的探讨彩色多普勒超声在子宫下段剖宫产切口瘢痕妊娠早期诊断及介入治疗中的应用。方法对本院收治的15例子宫下段剖宫产切口瘢痕妊娠患者进行彩色多普勒超声检查,确诊后行经阴道超声引导下孕囊穿刺注射甲氨蝶呤治疗,术后动态观察孕囊变化。结果 15例子宫下段剖宫产切口瘢痕妊娠均为胎囊型,孕囊形态结构完整,孕囊前有子宫壁肌层完整覆盖,彩色多普勒示孕囊周边呈较丰富环状血流信号;15例确诊后行经阴道超声引导下孕囊穿刺注射甲氨蝶呤均一次性成功,治愈率为100%;穿刺治疗后孕囊逐渐变小,随后脱落或被吸收,血β-HCG逐渐下降至正常。结论经阴道彩色多普勒超声能早期确诊子宫下段剖宫产切口瘢痕妊娠,还可行超声引导下孕囊穿刺治疗及术后动态观察,值得临床推广应用。     

经阴道超声在诊断异位妊娠中的应用

目的：探讨阴道超声诊断异位妊娠在临床治疗中的价值。方法：对疑为早期异位妊娠的病人经阴道超声检查和随访。结果：48例经阴道超声诊断出的异位妊娠，破裂型9例，未破裂型38例，宫内宫外同时妊娠1例，而未破裂型异位妊娠的诊断尤为重要，占总数79％，其声像图为附件区可见妊娠囊、空妊娠囊、Dount征和混合性回声四种。结论：经阴道超声检查，特别对未破裂型异位妊娠的检查，使异位妊娠的诊断时间大大提高，从而减少失血性休克，降低死亡率，指导临床治疗有着极其重要的意义。     

未破型异位妊娠的超声诊断

目的探讨超声对未破型异位妊娠发生部位诊断的临床价值.方法回顾性分析经手术及病理证实的未破型异位妊娠的超声图像特征.结果输卵管峡部、壶腹部妊娠表现为子宫一侧的环状回声包块;输卵管间质部妊娠表现为一侧宫角的向外膨隆,胎囊外侧缘无子宫肌壁的环绕;宫角妊娠表现为一侧宫角的饱满,胎囊外侧有肌壁的包绕,下段与宫腔相通;残角子宫妊娠表现为位于子宫一侧的正圆形囊性包块,周围环绕子宫肌壁;宫颈妊娠表现为宫颈增大,子宫呈葫芦形,内口紧闭,宫颈内有胎囊.结论腹部超声(TAS)、阴道超声(TVS)联合检查,结合临床综合分析能提高对未破型异位妊娠部位的诊断.     

不典型异位妊娠的声像图分析

目的分析和总结不典型输卵管、宫颈、宫角及卵巢妊娠的声像图特点。方法对临床未知妊娠部位的38例患者行二维、彩色多普勒及脉冲多普勒超声观察,并与手术及病理结果对照分析。结果不典型输卵管妊娠表现为输卵管增粗,横切面可见小的厚壁囊性结构,内无卵黄囊及胚芽,彩色血流显像无明显血流信号;卵巢妊娠未破裂时包块周围常可见卵巢组织,卵巢妊娠发生流产或破裂时,超声诊断较为困难;早期宫颈妊娠子宫外形呈葫芦状,宫颈膨大,可见以实性为主的囊实性包块,宫颈内口关闭;早期宫角妊娠时患侧宫角增大,厚壁的囊性结构与宫腔相通,周围有较厚均匀一致的肌层环绕。结论掌握不典型输卵管妊娠、卵巢妊娠及宫颈、宫角妊娠的声像图特点,可提高超声对异位妊娠的诊断能力。     

子宫角妊娠的超声特征与误诊分析

目的总结子宫角妊娠超声声像图特征和鉴别诊断要点.方法 与手术病理检查结果对比,对常规腹部超声及经阴道超声诊断的93例子宫角妊娠患者的术前超声声像图表现及超声分型特征进行总结.结果 与手术病理诊断结果对比显示,术前超声诊断子宫角妊娠与手术病理诊断符合66例(82.5%,66/80),其中妊娠囊型子宫角妊娠55例,混合包块型子宫角妊娠11例;误诊为输卵管间质部妊娠11例、残角子宫妊娠2例、绒癌1例;术前超声误诊率为17.5%(14/80);术前超声表现为附件区异位妊娠包块13例,术中显示为子宫角妊娠包块破裂,超声未定位和分型诊断.子宫角妊娠的超声特征为妊娠囊位于膨隆的一侧子宫角,周边有薄层肌壁包绕,子宫角妊娠包块与宫内膜相连.14例子宫角妊娠误诊原因:(1)超声显示子宫角包块与子宫内膜不连接、包块不为子宫肌层包绕,误诊为输卵管间质部妊娠.(2)子宫角外侧肌层厚,误诊为残角子宫妊娠.(3)子宫角包块血流丰富,肌层菲薄,误诊为绒癌.结论 经腹部联合经阴道超声能对子宫角妊娠病变做出准确诊断,依据超声诊断要点综合评估有助于子宫角妊娠的鉴别诊断.     

经阴道子宫输卵管插管介入治疗输卵管妊娠

目的：研究经阴道子宫输卵管插管注入甲氨蝶呤治疗输卵管妊娠的方法。方法：在X线透视下,采用输卵管再通专用器械,先行子宫输卵管造影了解孕囊位置,穿刺孕囊并注射甲氨蝾呤,使孕囊死亡。选择同期符舍保守治疗条件的输卵管妊娠96例作为对照组,采用肌内注射甲氨蝶呤治疗,对两组效果进行比较。结果：治疗组42例插管均一次成功,39例治愈,治愈率92．86％。3例治疗后13-hCG下降,转手术治疗。11例术后3个月输卵管造影提示惠侧输卵管通畅。结论：经阴道子宫输卵管插管介入治疗是输卵管妊娠简便、安全、有效的治疗方法,可最大限度的保持输卵管通畅,从而保留生育功能,有较大的临床应用价值。     

Diagnosis of early intramural ectopic pregnancy

Intramural ectopic pregnancy is a very rare diagnosis. Establishing a diagnosis is difficult and is often made intraoperatively. Demonstration of a live extrauterine gestation is the only specific sign of such a pregnancy. A small number of ectopic pregnancies are interstitial or cornual pregnancies. Rupture of an intramural ectopic pregnancy is a serious clinical complication. Diagnosis of this ectopic pregnancy can sometimes be made using 2-dimensional transvaginal ultrasound (TVS), but it may also require 3-dimensional TVS. We present the case of a 25-year-old gravida 0, para 0 woman with amenorrhea lasting 6(+5) weeks. Previous surgery included a right adnexectomy for torsion of a right dermoid cyst. The patient's serum hCG was elevated. TVS provided a detailed view of the endometrial cavity. The results of 2-dimensional TVS suggested the presence of an ectopic pregnancy. The sonogram showed a gestational sac with an embryonic pole and a yolk sac, which was separated from the endometrium. Use of 3-dimensional TVS demonstrated a live embryo in a gestational sac surrounded by myometrium below the right cornu lying outside the endometrium. This finding was confirmed by laparotomy and the conceptus was excised. The patient had an uneventful postoperative course and was discharged 7 days after surgery. In our case, the previous adnexectomy was an identifiable risk factor. Nonetheless, making a diagnosis of an intramural pregnancy was challenging. Suspicion may arise when sonography has revealed an intramural gestational sac.     

Cesarean Scar Pregnancy

A cesarean scar (ectopic) pregnancy occurs when a pregnancy implants on a cesarean scar. This condition is an uncommon but potentially devastating occurrence. The incidence is increasing as cesarean deliveries become more common. Early recognition of the salient sonographic findings is critical because a delay can lead to increased maternal morbidity and mortality. Magnetic resonance imaging is a valuable troubleshooting tool when sonography is equivocal or inconclusive before therapy or intervention. Early diagnosis by sonography directs therapy and improves outcomes by allowing preservation of the uterus and future fertility. We review the imaging features, differential diagnosis, complications, and treatment of cesarean scar pregnancies in the first trimester.     

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] 评价彩色多普勒超声在诊断剖宫产术后子宫瘢痕妊娠中的价值.[方法] 11例子宫下段瘢痕妊娠患者,采用经腹经腔内联合彩超检查,观察孕囊位置,妊娠物与子宫切口处肌层的回声、血流分布及两者的分界、宫腔宫颈情况等.[ 结果] 所有患者在宫腔正常部位未见到孕囊.孕囊或包块着床于子宫下段切口肌层处,根据其超声图像表现分为2种类型：①孕囊型2例,②流产包块型9例.[ 结论] 经腹经腔内彩超对剖宫产术后子宫下段瘢痕妊娠的早期诊断有着重要作用.     

卵黄囊在早孕超声诊断中的价值探讨

目的通过对早期妊娠卵黄囊的观察,探讨其在早孕超声诊断中的临床价值。方法 2008年5月-2009年1月应用阴道超声诊断仪观察536例早孕患者卵黄囊的形态、大小及卵黄囊的数目,根据结果分为卵黄囊正常及异常组,比较卵黄囊的增长情况与妊娠预后的关系。结果 504例正常组中,501例正常妊娠结局的卵黄囊大小从孕5～11周持续增长,此后逐渐缩小,孕12周后消失;另3例为宫外孕而中止妊娠。卵黄囊异常组32例。正常组和异常组的卵黄囊大小及形态有统计学意义（P〈0.05）。结论卵黄囊超声影像学改变可作为诊断早孕及预测妊娠发展和转归的可靠手段。