宫内早孕合并左侧输卵管伞部妊娠一例及文献复习

宫内孕合并异位妊娠临床罕见,近年来随着辅助生殖技术的兴起,其发病率有所上升。其临床表现不一,主要取决于种植于宫腔外的异位妊娠胚胎的发育情况,轻者可无明显症状或体征,严重者可致患者腹腔大出血、失血性休克甚至死亡。由于宫内孕合并异位妊娠十分凶险,临床上应尽早诊断,采取个体化治疗,以确保母儿安全。现报道1例罕见的宫内早孕合并左侧输卵管伞部妊娠病例,并进行相关文献复习,总结宫内孕合并异位妊娠的相关知识,以期引起妇产科医生的重视。     

宫内孕误诊为异位妊娠18例分析

宫内孕误诊为异位妊娠１８例分析马艳萍章晓梅异位妊娠是危及育龄妇女生命和健康的常见疾病，近年来有上升的趋势，故越来越受到临床医师的重视，但部分宫内着床较晚的宫内孕，临床表现及体征与异位妊娠相似。本文对我院１８例宫内孕误诊为异位妊娠病例进行回顾性总结。一...     

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。     

宫内妊娠合并异位妊娠B超引导下经阴道异位胚胎减灭术3例临床分析

目的探讨B超引导下经阴道选择性减灭宫内妊娠合并异位妊娠中异位胚胎的临床应用价值。方法回顾性分析3例妊娠6~8周宫内妊娠合并异位妊娠经阴道超声引导下减灭异位妊娠胚胎,保留宫内正常妊娠胚胎患者的临床资料。结果 3例患者成功行选择性异位胚胎减灭术。其中1例合并右侧输卵管妊娠患者,妊娠7周选择性减灭右侧输卵管妊娠胚胎后,足月分娩一健康女婴;2例分别为合并宫颈妊娠和右侧宫角妊娠患者,妊娠7周+3和妊娠8周行选择性异位妊娠胚胎减灭后,现宫内妊娠23周+4和24周。未出现感染、出血等并发症。结论妊娠6~8周B超引导下经阴道选择性减灭异位妊娠胚胎,可达到终止异位妊娠的目的,并对宫内妊娠胚胎无明显影响。     

卵巢妊娠的诊断及治疗

卵巢妊娠是指受精卵在卵巢组织内种植和生长发育,根据受精卵种植的部位,将卵巢妊娠分为原发性与混合性两类;原发性卵巢妊娠指孕卵种植于卵巢上、卵泡内或卵泡外,包括卵巢表面、皮质内、髓质内。混合性卵巢妊娠孕卵囊壁由部份卵巢及其他组织所构成。其中以原发性卵巢妊娠为多见。原发性卵巢妊娠是一种罕见的异位妊娠,其发生率国内外文献报导中差异很大,占异位妊娠的0.36%～2.74%之间。据我院1964年～1988年25年间共收治异位妊娠707例,其中原发性卵巢妊娠20例,其发生率为2.82%,而近6年卵巢妊娠就占8例,为同期异位妊娠169例的4.73%,有明显增加趋势,与Beral 及Halatt 等报导一致,并认为这可能与宫内节育器的广泛应用有关。这8例中有6例置宫内节育器,但宫内节育器导致卵巢妊娠的机理尚不明。根据Spiegelberg 提出原发性卵巢妊娠诊断的标     

子宫内膜厚度、β-HCG和孕酮联合检测对异位妊娠与早早孕诊断价值的探讨

目的:探讨异位妊娠与早早孕鉴别诊断的特征性依据,避免误诊误治。方法:对132例疑似异位妊娠的病例测量子宫内膜厚度及测定血清-βHCG及孕酮值。结果:本研究的所有病例血清-βHCG及孕酮值高于正常非妊娠者。但宫内妊娠组子宫内膜厚度及孕酮值明显大于异位妊娠组,P<0.01;正常宫内妊娠的子宫内膜厚度、-βHCG及孕酮值大于宫内妊娠流产组。结论:血清-βHCG及孕酮值是确定妊娠的指标,但难以鉴别异位妊娠和尚未形成宫内孕囊的早早孕及宫内妊娠流产,结合子宫内膜厚度则能预测妊娠的趋向,提示妊娠的着床部位,为防止误诊提供了一个有价值的临床早期诊断指标。     

宫腹腔镜联合诊治宫内妊娠合并子宫肌壁间妊娠1例

正子宫肌壁间妊娠(IMP)为罕见病,发生率约为1∶30 000次妊娠~([1]),而合并宫内妊娠则鲜有报道。但随着人工流产、剖宫产增多及宫内操作机会增加,其发生率也逐渐上升。肌壁间妊娠存活病例极其罕见~([2]),多数孕周不超过12周即出现子宫破裂等严重后果,临床常误诊为妊娠滋养细胞疾病、妊娠物残留、宫角妊娠、子宫肌瘤~([3])。患者接受错误的治疗,例如化疗或反复清宫,对患者造成极大     

微型腹腔镜手术在输卵管复通中的应用

目的:探讨微型腹腔镜手术在输卵管吻合复通中的应用价值。方法:回顾性分析66例输卵管绝育术后因需生育而行吻合复通术的患者资料,将其中36例利用微型腹腔镜完成输卵管复通术者(腹腔镜组),并与同期完成的开腹下输卵管复通术30例(开腹组)作对比研究。结果:所有患者手术均顺利完成,术后随访5～ 48个月。腹腔镜组宫内妊娠27例,异位妊娠2例,未孕7例,宫内妊娠率75.00%,总妊娠率80.56%。开腹组宫内妊娠15例,异位妊娠3例,未孕12例,宫内妊娠率50.00%,总妊娠率60.00%。宫内妊娠率、总妊娠率组间差异有统计学意义(P<0.05)。合并盆腔粘连者,术后宫内妊娠率、总妊娠率组间比较,差异有统计学意义(P<0.05)。结论:与开腹手术相比,微型腹腔镜手术用于输卵管复通具有损伤小、出血少、术后恢复快、术后宫内妊娠率提高的优势,尤其适合于合并盆腔粘连的患者。     

孕酮测定在诊断停经6周内异位妊娠的价值探讨

目的:探讨血清孕酮水平测定在诊断停经6周内异位妊娠的价值.方法:检测71例异位妊娠患者(异位妊娠组)血清孕酮值,并以69例入院安胎成功的宫内早孕且停经6周内的患者(宫内妊娠组)血清孕酮值作为对照.结果:异位妊娠组血清孕酮明显低于宫内妊娠组(P<0.01),取异位妊娠组血清孕酮值第95百分位为截断值,P95=47.6 nmol/L,鉴别诊断停经6周内异位妊娠和宫内妊娠的敏感性94.4%,特异性97.1%.结论:血清孕酮水平对孕6周内异位妊娠与宫内早孕有良好的鉴别诊断价值.     

妊娠合并绒癌

妊娠合并绒癌临床和病理上均是十分罕见的 ,其确切的发生率均难以肯定。因此对死婴和母体胎盘等也均未作常规病理检查。妊娠合并绒癌也可分宫内妊娠合并绒癌和宫外妊娠合并绒癌。一般所指妊娠合并绒癌 ,均是指宫内妊娠合并绒癌。1　含意宫内妊娠合并绒癌又有二个涵意 :1正常妊娠时胎盘某一部分的绒毛恶变为绒癌 ,也即原发于正常胎盘的绒癌 ,也称原位绒癌或称宫内妊娠始发绒癌 ;2双胎中一个胎盘正常 ,而另一个胎盘为绒癌 ,此称妊娠合并绒癌。两者含意稍有不同 ,但症状、体征与处理基本相同。通常在临床上也均混称妊娠合并绒癌 ,在查明其原因…     

Heterotopic Pregnancy Complicating In Vitro Fertilization

Summary: A review was undertaken of the cases of heterotopic pregnancy resulting from in vitro fertilization/embryo transfer (IVF/ET) and frozen embryo replacement (FER) in a 6-year cohort of women at National Women's Hospital in Auckland. The incidence of heterotopic pregnancy was 2.9% (5 cases) in 173 clinical pregnancies resulting from 901 embryo replacements. Of the 5 women with heterotopic pregnancy, 1 had unilateral tubal patency and 4 had bilateral tubal blockage; 3 had 'high responder' peak serum oestradiol levels (greater than 9,000 pmol/L) prior to oocyte pick-up (OPU); 3 had a serum human chorionic gonadotrophin beta subunit (beta-HCG) level greater than 600 IU/L on Day 14 following embryo transfer (ET) in the absence of a multiple intrauterine gestation on subsequent ultrasound scan. In the 4 women in whom unequivocal diagnosis of heterotopic pregnancy was not made on the initial ultrasound scan, there was delay in appropriate management, in 1 for more than 5 months. In conclusion, early IVF pregnancies require a transvaginal ultrasound scan performed by a sonographer experienced in the diagnosis of ectopic pregnancy and management of early pregnancy complications by clinicians in close consultation with the IVF centre itself. No single risk factor, laboratory test or combination of these is sensitive or specific enough to predict the occurrence of heterotopic pregnancy. The first-line surgical treatment of heterotopic pregnancy should be laparoscopic salpingectomy with excision of all except the intramural portion of the affected Fallopian tube.     

An Unusual Set of Triplets: Twin Intrauterine Pregnancy with Singleton Extrauterine Pregnancy

Heterotopic pregnancy (simultaneous intrauterine and extrauterine pregnancy) is an extremely rare clinical phenomenon occurring approximately 1 in 30,000 pregnancies (1) or 1 in 2,000,000 live births (2). There have been 435 cases reported in the world literature up to 1956 (3). Simultaneous viability in heterotopic pregnancy is an even rarer event occurring in only 10.6% of cases (3).     

Myocardial Infarction in Pregnancy

Myocardial infarction is a rare complication during pregnancy, with an estimated incidence of one in 10,000 pregnancies. Less than 100 cases have been reported. Pregnancy is associated with profound alterations in the maternal cardiovascular system, making pregnancy in the presence of maternal cardiac disease hazardous. Labour and delivery increase cardiovascular stress. Maternal mortality in pregnancies complicated by myocardial infarction is 35 percent. Delivery within two weeks of infarction, or reinfarction during pregnancy is associated with mortality as high as 50 percent. Perinatal mortality is related to maternal outcome.Clinical management of the pregnant woman with myocardial infarction should be multidisciplinary, involving input from obstetrics, cardiology, and anaesthesia. The goals of management are to decrease cardiac work, prevent extension of infarction, increase oxygenation, and prevent complications. During labour and delivery, adequate analgesia, preferably epidural, is essential. The mode of delivery is controversial, however most authors recommend that Caesarean section be reserved for obstetric indications, with assisted vaginal delivery to shorten the second stage of labour being the preferred method. Cardiac arrest in pregnancy is a rare event, but one for which physicians should be prepared. Perimortem Caesarean section to save the fetus should be considered if maternal resuscitation is unsuccessful. Early recognition of myocardial infarction will facilitate effective management, prevention of complications, and improvement in maternal and perinatal survival.     

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。     

79例妊娠合并系统性红斑狼疮临床资料分析

目的　探讨影响妊娠合并系统性红斑狼疮 (SL E)妊娠结局的相关因素 ,提出 SL E患者最佳的受孕时机和孕期的监护 ,预防妊娠 SL E的恶化及 SL E对妊娠的不良影响 ,以提高围产质量。　方法　回顾分析 79例妊娠合并 SL E的临床资料。　结果　妊娠合并 SL E其新生儿体重明显低于正常妊娠组 ,二次以上妊娠组新生儿妊娠结局较初次妊娠组差。在 SL E活动期受孕者其妊娠结局亦较在 SL E缓解期受孕组差 ,SL E肾炎型孕妇妊娠结局较非肾炎型组差。　结论　 SL E患者应首先控制疾病的活动 ,在产科医师和内科医师的指导下受孕 ,并应避免多次妊娠对下次妊娠结局带来的不利影响。泼尼松是目前安全可靠的妊娠期预防 SL E恶化 ,控制 SL E活动的药物之一。 SL E孕妇应加强孕产期的监护 ,以争取良好的妊娠结局     

体外受精--胚胎移植后宫内宫外同时妊娠4例分析

目的 :探讨体外受精、胚胎移植后宫内宫外同时妊娠的危险因素、诊断及治疗。方法 :回顾性分析 1999年 3月至 2 0 0 1年 3月体外受精—胚胎移植后临床妊娠的 179人中发生宫内宫外同时妊娠的 4例患者。结果 :4例患者在明确诊断后行患侧输卵管切除术 ,术后 3例宫内继续妊娠 ,1例难免流产。结论 :体外受精—胚胎移植后 ,宫内宫外同时妊娠的发生率增加 ,尤其是既往有异位妊娠史及输卵管积水患者。加强 B超监测有助于早诊断、早治疗     

妊娠合并急性肾盂肾炎48例分析

探讨妊娠期急性肾盂肾炎（ＧＡＰＮ）对妊娠的影响及其人治疗措施。方法 对４８例ＧＡＰＮ进行回顾性分析。结果 ＧＡＰＮ的主要致病菌为大肠杆菌（６５％），且８２％的杆地氨苄青霉素耐药。抗菌疗程４周者再发率（１０％）明显低于３周者（３２％），差异显著（Ｐ〈０．０１）。４８全名流产１例，早产３例。结论 ＧＡＰＮ多在妊娠中、晚发病，重得可致流产、早产。治疗首选头孢菌素耐药闻程以４周为好。应重视孕早期尿菌普查，     

Tubal Pregnancy Following Tubal Embryo Transfer into the Contralateral Fallopian Tube

Ectopic and heterotopic pregnancy may occur with increased frequency following assisted reproductive technology (ART) procedures. In addition, there may be unusual sites of implantation, which may cause atypical and confusing clinical manifestations. We present a case of tubal pregnancy after tubal embryo transfer (TET) to the contralateral fallopian tube. Four embryos were transferred to the left fallopian tube by laparoscopy, but the patient developed a right tubal pregnancy, possibly as a result of intrauterine or intra-abdominal migration of the embryo. ART patients must be followed closely soon after the procedure, and there should be a high index of suspicion for an unusual implantation site.     

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。     

异位妊娠时子宫内膜的形态变化

目的：探讨异位妊娠时子宫内膜形态变化的规律。方法：回顾分析我院２１７例异位妊娠子宫内膜的形态变化。结果：异位妊娠时子宫内膜变化有７种类型：（１）蜕膜和Ａｒｉａｓ－Ｓｔｅｌａ反应（Ａ－Ｓ反应）；（２）高度分泌反应；（３）分泌反应不同步；（４）部分呈分泌反应、部分呈增生反应，并出现一种“小Ａ－Ｓ”腺体；（５）早、中、晚分泌期；（６）增生反应；（７）腺囊型增生过长。异位妊娠时内膜形态与有无阴道流血、流血时间长短及尿ｈＣＧ水平有关。结论：不能以是否出现蜕膜和Ａ－Ｓ反应做为诊断异位妊娠的依据，须结合病史和实验室检查才能准确判断。