孕囊型与包块型剖宫产瘢痕妊娠的超声特征及临床特点分析

目的 比较分析孕囊型剖宫产瘢痕妊娠(gestational cesarean scar pregnancy, GCSP)与包块型剖宫产瘢痕妊娠(mass cesarean scar pregnancy, MCSP)的超声特征及临床特点。方法 回顾性分析2016年8月至2021年12月在上海交通大学医学院附属第九人民医院经临床随访或手术病理证实的剖宫产瘢痕妊娠(cesarean scar pregnancy, CSP)108例,根据超声内部回声分为孕囊型与包块型,其中GCSP 86例,MCSP 22例,比较分析两种分型的超声特征及临床特点。结果 GCSP组86例,其中66例孕囊部分或小部分着床于瘢痕处,大部分位于宫腔下段,38例瘢痕处剩余肌层厚度>3 mm, 28例瘢痕处剩余肌层厚度≤3 mm; 20例孕囊完全着床于瘢痕处,瘢痕处剩余肌层厚度≤3 mm。MCSP组22例,混合性包块完全着床于子宫下段前壁瘢痕处,瘢痕处剩余肌层厚度≤3 mm。超声特征：MCSP组较GCSP组病灶更大、瘢痕处剩余肌层更薄、病灶血供更丰富(P<0.05);在子宫位置、宫底部子宫内膜厚度及盆腔积液方面...     

剖宫产术后子宫瘢痕妊娠6例

剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)是孕囊着床于前次剖宫产瘢痕处的异位妊娠,是一种少见而危险的妊娠.     

阴道超声鉴别宫内妊娠及CSP的简便方法探究

目的 探究经阴道超声(transvaginal ultrasound,TVS)鉴别宫内妊娠(intrauterine pregnancy,IUP)及剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的简便方法.方法 回顾性分析2019年7月～12月天津医科大学总医院IUP及术后病理证实为CSP的T...     

剖宫产瘢痕妊娠大出血11例

剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)是妊娠囊种植在前次剖宫产手术瘢痕部位的子宫肌层,是一类很罕见的异位妊娠.若处理不当,则容易导致大出血,甚至孕妇死亡.现就本院近2年收治的11例瘢痕妊娠大出血的病例总结如下.     

11例甲型H1N1流感孕产妇的临床分析

Objective To study the clinical characteristics and therapeutic effect of pregnant women infected with severe influenza A(H1N1), to survey the disease effects for the newborns. Methods The clinical data of 11 pregnant women infected with influenza A(H1N1 ) in our hospital from November to December 2009 were analyzed retrospectively. Results All the cases were in serious conditions, and 3 cases were in critical. All the patients were with symptoms of fever and cough, the temperature were in 38.7-39.6 ℃, and duration were 3-14 days. There were 9 cases with low lymphocytes, and 9 cases with high WBC. CRP were elevated in all the cases ( 12-129 mg/L), 9 cases were with hypochromia (22.4-30.2 mg/L). X ray showed increases of pulmonary hilar density for all the cases. By comprehensive treatment, 10 patients were cured and one showed marked progress. 9 cases continued pregnacy. One infant with septicemia was cured, other newborns and fetus were in good condition. Conclusions Pregnant women infected with influenza A (H1N1) are likely to develop severe condition. It is important to use antiviral treatment promptly,supplementary comprehensive treatment. Continuing pregnancy is safe, but the outcome to newborn needs further study.     

剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用

Objective To observe the application of cesarean section and vaginal delivery in parturient term pregnancy with fetal distress. Methods One hundred and six cases of parturient term pregnancy with fetal distress were selected, SO cases of cesarean section as group A, 56 cases of vaginal delivery as group B, newborn outcome and condition of the large maternal cervix data when fetal distress between two groups were compared. Results The neonatal asphyxia rate was 14.0% (7/50) in group A and 16.1 % (9/56 ) in group B, there was no significant difference between two groups (P＞0.05); the rate of the large maternal cervix data in delitescence in group A was higher than that in group B [54.0% (27/50) vs. 26.8% (15/56) ](P＜ 0.05); the rate of the large maternal cervix data in active stage deceleration phase in group A was lower than that in group B [4.0%(2/50) vs. 23.2%(13/56)](P＜0.05). Conclusion Cesarean section and vaginal delivery in parturient term pregnancy with fetal distress can get a good neonatal outcomes, maternal clinical condition should select the appropriate surgical approach, and effort to reduce cesarean section rates.     

辅助生殖技术后输卵管间质部妊娠 10 例临床分析

Objective： This is ten cases report of the interstitial pregnancy after assisted reproductive technology （ART）. Methods：Ten cases of the interstitial pregnancy after IVF/ICSI-ET in our center, from July 2011 to July 2013, were retrospectively analyzed. Clinical features and related risk factors were summarized. Results：Ten patients aged （32.9±3.7）years, with the tubal-related operation history, accepted IVF/ICSI treatment due to their tubal factors. Four cases had a history of ectopic pregnancy. Nine patients had been transferred 2 embryos in their ART cycles,and only 1 case transfered a single embryo. As for clinical manifestations,6 cases were firstly suspected for ectopic pregnancy by B ultrasound, 1 case suffered from abdominal pain ,1 case had a small amount of vaginal bleeding,and the other 2 cases were complained of abdominal pain and vaginal bleeding. After diagnosed, eight patients underwent direct operation,one case successfully received MTX treatment while another one case underwent operation after her unsuccessful MTX treatment. Conclusions：The interstitial pregnancy after IVF/ICSI was possibly related to abnormal function of fallopian tube after the tubal-related operation, especially tube resection or the proximal tubal occlusion. The number of transferred embryos should be controlled in those IVF/ICSI patients with high-risk factors,while B ultrasound monitoring after transplantation and health education should be added so as to reduce the adverse outcome of the interstitial pregnancy after ART. [ABSTRACT FROM AUTHOR]     

剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用

目的 探讨剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用情况.方法 选择足月妊娠临产胎儿窘迫106例,其中施行剖宫产术结束分娩50例(A组),施行阴道助产术结束分娩56例(B组),比较两组的新生儿结局及胎儿窘迫时产妇宫口开大情况.结果 A、B组新生儿窒息率[14.0%(7/50)比16.1%(9/56)]比较差异无统计学意义(P＞0.05);A组胎儿窘迫时产妇宫口开大处于潜伏期率高于B组[54.0%(27/50)比26.8%(15/56)](P＜0.05),处于活跃期减缓阶段率低于B组[4.0%(2/50)比23.2%(13/56)](P＜0.05).结论 剖宫产术与阴道助产术应用于足月妊娠临产胎儿窘迫中均能获得良好的新生儿结局.临床上应根据产妇情况选择适合的手术方式,并努力降低剖宫产率.

Abstract：

Objective To observe the application of cesarean section and vaginal delivery in parturient term pregnancy with fetal distress. Methods One hundred and six cases of parturient term pregnancy with fetal distress were selected, SO cases of cesarean section as group A, 56 cases of vaginal delivery as group B, newborn outcome and condition of the large maternal cervix data when fetal distress between two groups were compared. Results The neonatal asphyxia rate was 14.0% (7/50) in group A and 16.1 % (9/56 ) in group B, there was no significant difference between two groups (P＞0.05); the rate of the large maternal cervix data in delitescence in group A was higher than that in group B [54.0% (27/50) vs. 26.8% (15/56) ](P＜ 0.05); the rate of the large maternal cervix data in active stage deceleration phase in group A was lower than that in group B [4.0%(2/50) vs. 23.2%(13/56)](P＜0.05). Conclusion Cesarean section and vaginal delivery in parturient term pregnancy with fetal distress can get a good neonatal outcomes, maternal clinical condition should select the appropriate surgical approach, and effort to reduce cesarean section rates.     

超声早期诊断剖宫产瘢痕妊娠分析

<正>剖宫产瘢痕妊娠(cesarean scars pregnancy,CSP)为罕见类型的异位妊娠,是指受精卵着床在原剖宫产瘢痕处。随着剖宫产率的增加,以及医生对该疾病认知的提高和超声检查水平的提高,CSP的发病率明显增高〔1〕。CSP易发生子宫破裂、阴道大出血,严重危及患者生命,因此对CSP早期正确诊断尤为关键。该研究就20例瘢痕妊娠的超声声像图表现进行分析,为该病的早期诊断及治疗提供有价值的依据。     

浙江省嘉兴地区初孕妇女自然流产状况研究

Objective To study the current status of spontaneous abortion of primigravid women in Jiaxing areas of Zhejiang province of China. Methods We analyzed the data from both perinatal healthcare surveillance program and spontaneous abortion, collected in Jiaxing areas by the Institute of Reproductive and Child Health, Peking University. The study population consisted of 14 769 primigravid women (excluding induced abortion, ectopic pregnancy and molar pregnancy as outcomes) attempting to become pregnant who registered between 1993 and 1995. Results 1454 spontaneous abortion cases were identified, with the spontaneous abortion rate as 9.8% (95% CI:9.3%-10.3%). The mean gestational weeks at pregnancy diagnosis were 7.6±2.1 weeks, the mean gestational weeks at miscarriage were (10.1±3.1) weeks and the incidence of first-trimester (≤12 weeks) spontaneous abortion was 7.3%(95%CI: 6.8%-7.7%), accounting for 73.7% of all the spontaneous abortion cases. A peak for risk of miscarriage was around 8-13 weeks, accounting for 37.7% of all spontaneous abortion. The observed multiple Cox regression model showed that increased spontaneous abortion rates were observed in women with age at pregnancy ≥30, being peasants and with higher education level. Conclusion The spontaneous abortion rate of primigravid women in Jiaxing areas was higher than in other areas of China. The maximum occurrence of spontaneous abortions was during period of 8-13 gestation weeks.     

经阴道彩色多普勒超声在子宫切口妊娠诊断及治疗中的应用价值

目的：探讨经阴道彩色多普勒超声在子宫切口妊娠诊断及治疗中的应用价值。方法回顾性分析102例子宫切口妊娠患者的经阴道彩色多普勒超声图像、临床治疗方案和预后。结果102例子宫切口妊娠中，61例为孕囊型，41例为混合团块型。除4例包块较小、血HCG低的患者外，余98例均行子宫动脉介入栓塞术，疗效显著。结论经阴道彩色多普勒超声可清楚地显示子宫切口妊娠病灶的位置、大小、外缘肌层厚度、血流灌注情况等，对临床治疗方案的选择及疗效评估具有重要的指导意义。     

剖宫产术后43例瘢痕妊娠的治疗的探讨

目的:探讨瘢痕妊娠的诊断及治疗。方法:对上海市第一妇婴保健院2003年~2007年收治的43例瘢痕妊娠患者进行回顾性分析,并对不同的治疗方法进行比较。结果:43例患者均通过超声明确诊断,2例行全子宫切除术,1例行次全子宫切除术,其余患者均保守治疗成功。方法包括25例患者使用甲氨喋呤(MTX)与经阴道超声孕囊穿刺术相结合治疗,18例患者使用MTX与介入治疗相结合。结论:超声可以在孕早期明确诊断,早期诊断及治疗可以获得满意的治疗效果。     

3D玻璃体成像技术结合彩色多普勒超声在瘢痕妊娠诊断中的应用价值

目的：探讨3D玻璃体成像技术结合彩色多普勒超声在瘢痕妊娠诊断中的应用价值。方法回顾性分析2009年5月-2012年7月我院收治的83例剖腹产瘢痕妊娠患者的经腹、经阴道以及3D玻璃体模式彩色多普勒超声图像。结果83例患者中：①孕囊型40例,其中25例有活胎芽,15例无胎芽或胎芽停育;38例胎囊较小、胎芽小或无,故采取甲氨蝶呤（MTX）及介入治疗,2例行子宫半切手术;②团块型42例,其中全子宫切除7例,25例MTX及介入治疗,10例保守治疗;③超声误诊1例,诊断准确率为98.8%。两种类型患者的绒毛种植区均可见较丰富的血流信号,3D成像成彩团样。结论3D玻璃体成像技术结合彩色多普勒超声可为瘢痕妊娠的定位和定性诊断提供较准确的信息,有助于临床选择合适的治疗方案,估计病程及转归。     

剖宫产瘢痕妊娠70例临床分析

目的探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)临床诊治方法及结局。方法收集2012年1月至2014年12月厦门大学附属第一医院70例CSP患者的临床资料并作回顾性分析。结果70例诊断为CSP的患者孕周为5~16周,孕周≤12周的65例患者选择终止妊娠,其中24例行子宫动脉栓塞+刮宫术,6例行经阴道病灶切除术,3例行宫腔镜手术,4例行腹腔镜手术,20例药物治疗配合刮宫术,8例单纯药物治疗,均达到治愈目的,无1例子宫切除。5例患者诊断时孕周为14~16周,选择继续妊娠,其中1例23周死胎并胎盘植入出血,切除子宫;4例在27~32周之间剖宫产,3例新生儿存活。结论 CSP是剖宫产术后严重的远期并发症,应根据具体情况选择个体化治疗,虽然继续妊娠可能分娩活婴儿,但孕妇面临胎盘植入大出血导致子宫切除的风险也增加。     

阴式子宫疤痕妊娠病灶清除术治疗Ⅰ型剖宫产术后疤痕妊娠的效果观察

目的探讨阴式子宫疤痕妊娠病灶清除术治疗Ⅰ型剖宫产术后疤痕妊娠(CSP)的临床疗效。方法选取我院收治的70例Ⅰ型CSP患者,随机分为观察组和对照组各35例。对照组采用子宫动脉栓塞甲氨喋呤(MTX)联合清宫术治疗,观察组采用阴式子宫疤痕妊娠病灶清除术治疗。比较两组的手术时间、术中出血量、住院时间、治愈率、超声疤痕处包块消失时间、月经恢复时间及β-HCG转阴时间。结果与对照组比较,观察组的手术时间较长,术中出血量较少,住院时间、超声疤痕处包块消失时间和月经恢复时间较短,治愈率较高(P均<0.05)。两组患者的β-HCG转阴时间比较无统计学差异(P>0.05)。结论阴式子宫切口疤痕妊娠病灶清除术治疗Ⅰ型CSP具有操作简单、疗效显著、创伤性小等优点,值得临床推广。     

经阴道彩超对子宫下段瘢痕妊娠的诊断价值

目的探讨经阴道彩超扫查对剖宫产术后子宫下段瘢痕妊娠(CSP)的诊断价值。方法回顾性分析2010年1月²013年12月经阴道彩超扫查的剖宫产术后CSP 18例临床资料,并与手术病理诊断结果进行比较,探讨其诊断符合率。结果经阴道彩超明确诊断为CSP 16例,未明确诊断1例,误诊1例,诊断符合率88.89%(16/18);手术病理诊断为CSP 18例,诊断符合率100.00%(18/18),二者的诊断符合率无统计学差异(p>0.05)。结论经阴道彩超扫查能清晰显示孕囊着床部位与子宫下段瘢痕的关系,以及子宫下段瘢痕处肌层的厚度\血流分布等情况,诊断符合率高,是剖宫产术后子宫下段瘢痕妊娠首选的扫查方法。     

剖宫产术后再次妊娠人工流产临床分析

目的探讨剖宫产术后再次妊娠行人工流产的危险性及临床治疗方法。方法对剖宫产术后再次妊娠5000例患者在静脉麻醉下行负压吸引术,其中有1740例在腔内B超引导下行人工流产术。结果人工流产完成较满意,无1例发生子宫穿孔及漏吸,术中出血较多有50例,26例出现大出血,为子宫疤痕处妊娠,其中9例经保守治疗无效,行子宫切除术,17例经子宫动脉栓塞及对症处理后行化疗杀胚等治疗后痊愈出院。结论剖宫产术后因子宫的变化增加了人流手术的操作难度,更易造成术中及术后并发症。其中剖宫产术后子宫疤痕处妊娠（CSP）是罕见而危险的妊娠类型,我院其发生率约为0.52%,应早期诊断,避免盲目吸宫,也可以在B超下及时发现及诊断CSP,先给予子宫动脉栓塞治疗,再吸宫,避免宫腔操作发生致命性大出血。     

剖宫产瘢痕妊娠10例诊治方法探讨

目的:探讨剖宫产瘢痕妊娠的诊治方法。方法:对2004年～2008年间在石家庄市第四医院收治的10例剖宫产瘢痕妊娠病例进行回顾性分析。结果:剖宫产瘢痕妊娠10例,7例由阴道彩色超声(TV-US)明确诊断后在子宫动脉栓塞术后3天由B超引导行吸宫术,1例外院误诊早孕行人流术后阴道间断出血,B超提示子宫下段强回声团块,予肌注MTX保守治疗成功,1例TV-US提示孕囊距子宫峡部浆膜层0.3 cm,行宫腔镜下人流术,1例B超提示子宫瘢痕处包块突向盆腔,在全麻下宫腹腔镜联合行剖宫产瘢痕妊娠病灶清除术。结论:阴道彩色超声是诊断剖宫产瘢痕妊娠的主要手段。子宫动脉栓塞辅助吸宫术是安全有效的治疗方法,宫腹腔镜的选择可以根据妊娠囊的种植部位而定,通过宫腔镜检查定位,突向宫腔的孕囊行宫腔镜手术清除;反之,对异位妊娠囊植入深者适合采用腹腔镜手术处理。     

经阴道彩超诊断及鉴别诊断子宫疤痕妊娠的价值

目的:评价经阴道彩超对于剖宫产术后瘢痕处妊娠的诊断与鉴别诊断价值。方法:回顾性分析32例剖宫产术后疤痕部位妊娠患者的超声检查结果及疤痕妊娠的图像特点,比较经阴道彩超与B超或经腹彩超对疤痕妊娠诊断的准确率。结果:根据声像图特征将疤痕妊娠分为孕囊型和包块型;经阴道彩超对孕囊型妊娠的诊断准确率明显高于B超或经腹彩超(P<0.05)。结论:经阴道彩超对剖宫产术后子宫切口瘢痕妊娠的诊断及鉴别诊断有重要价值。     

剖宫产瘢痕妊娠的个体化治疗

目的:探讨剖宫产瘢痕妊娠(CSP)的个体化综合治疗方法。方法:2006年12月～2012年12月,根据剖宫产史、妊娠表现、经阴道超声诊断,确诊CSP患者38例。按血β-人绒毛促性腺激素(β-HCG)水平、妊娠囊与子宫切口的关系及局部血运情况,26例首选甲氨蝶呤(MTX)化疗,10例首选清宫术,2例首选手术治疗,结果:26例经MTX化疗后,15例患者仅保守治疗未行清宫术,11例待血HCG下降80%～90%、病灶血流减少或消失后行病灶清除术;10例患者首选清宫术,均痊愈出院。结论:CSP的治疗应依据血β-HCG水平和病灶部位、表面肌层厚度、血供及阴道流血情况,选择个体化综合治疗方式。