残角子宫妊娠至 34+周合并胎盘植入 1例分析

目的探讨残角子宫妊娠的妊娠机制、临床诊断及处理，分析误诊原因。方法总结甘肃省妇幼保健院产科 2021年 7月收治的 1例残角子宫妊娠至 34+周并发胎盘植入病人的病史资料及诊疗方案，做文献复习。结果孕妇主诉停经 34+周，产检发现前置胎盘 5d。入院主要诊断“残角子宫妊娠，胎盘植入，孕 34+周，孕 2产 1”。入院后完善相关检查，行手术治疗，术中明确残角子宫妊娠合并胎盘植入，娩出胎儿后，切除残角子宫。分析误诊原因:未定期检查，中孕期未能分辨宫腔与宫颈的关系，病人有经阴道分娩史，故误诊为正常宫腔妊娠。中孕期检查如发现妊娠子宫位置较高，应充分扫查盆腔有无单角子宫存在，妊娠子宫与宫颈有无相连，有助于残角子宫妊娠漏诊的发现， MRI辅助检查在中晚孕期能提高残角子宫妊娠诊断的准确率。结论孕期需要加强监测及管理，仔细询问病史，详细专科查体，提高早期诊断率，降低母婴不良事件的发生。

Analysis of a case of residual horn uterus pregnancy at 34+weeks combined with placenta accreta

Objective To explore the pregnancy mechanism, clinical diagnosis and treatment of residual horn uterine pregnancy, andto analyze the causes of misdiagnosis.Methods The medical history and diagnosis and treatment plan of a patient with residual horn uterus pregnancy to 34+ weeks and placenta accreta who was admitted to the Department of Obstetrics, Gansu Maternal and Child HealthHospital in July 2021 were summarized, and the literature was reviewed.Results The pregnant woman complained of amenorrhea for 34+ weeks, and placenta previa was found for 5 days. Main diagnosis of admission included residual horn uterine pregnancy, placentalimplantation, 34+ weeks of gestation, pregnancy 2 and delivery 1. After admission, the relevant examinations were completed and surgi?cal treatment was performed. During the operation, the pregnancy of residual horn uterus with placenta accreta was confirmed. After thefetus was delivered, the residual horn uterus was removed. The causes of misdiagnosis were analyzed as follows: no regular examinationwas conducted, the relationship between uterine cavity and cervix could not be distinguished during the second trimester, and the patienthad a history of vaginal delivery, so it was misdiagnosed as normal uterine cavity pregnancy. MRI assisted examination can improve theaccuracy of diagnosis of residual horn uterus pregnancy in the second trimester and the third trimester.Conclusion During pregnancy,monitoring and management should be strengthened, medical history should be carefully inquired, and special physical examinationshould be carried out to improve the early diagnosis rate and reduce the occurrence of adverse events of mother and baby.