体外受精-胚胎移植后宫内妊娠合并子宫切口妊娠1例治疗分析

Clinical Analysis of A Case of Concurrent Intrauterine and Uterine Caesarean Scar Pregnancy after IVF-ET

目的:探讨在宫内合并子宫下段切口瘢痕妊娠(cesarean scar pregnancy,CSP)复合妊娠时治疗CSP同时保存宫内胎儿安全有效的方法。方法:在本中心行体外受精-胚胎移植(IVF-ET)助孕后妊娠患者1例,经反复阴道超声检查确诊宫内合并CSP。在患者充分知情同意的前提下,于移植后35 d行阴道超声引导下经阴道CSP胚胎穿刺减灭术,术后保胎及定期产检。结果:孕37周出现宫缩后急诊剖宫产一活婴,发育正常,术中下段切口处出血多,但宫缩正常,术程共出血1 000 ml,切口缝合后出血止,保留子宫,术后42 d复查子宫复旧好。结论:IVF-ET后出现剖宫产CSP合并宫内妊娠的复合妊娠极为罕见,早期诊断后通过阴道针刺抽吸妊娠胚囊可以达到终止切口瘢痕妊娠的目的,而且对宫内正常的妊娠囊无任何影响,是在保存宫内妊娠的同时治疗CSP切实有效的方法。

Objective： To explore safe and effective treatment strategies for intrauterine pregnancy complicated by caesarean scar pregnancy （CSP） that will be able to save the foetus within uterus. Methods： Repeated ultrasound scans confirmed concurrent intrauterine pregnancy and CSP in a patient that conceived through IVF-ET at our clinic. Reduction of the foetus that implanted on the caesarean scar by needle aspiration of the embryo was achieved via 35 d after embryo transfer. Anti-miscarriage treatments and regular obstetric check-up ensued. Results： Emergency caesarean section was performed when uterine contraction occurred in 37th week of gestation. A live infant was delivered and appeared developmentally normal. Heavy haemorrhage was observed at the caesarean incision in lower uterine segment. However, uterine contraction was normal. Intraoperative bleeding was 1 000 ml. Bleeding was stopped after suture of the caesarean scar and uterus was spared. Follow-up on 42th day after operation showed satisfactory uterine resurrection. Conclusion： Intrauterine pregnancy complicated by CSP after IVF-ET is extremely rare. Given early diagnosis, caesarean scar pregnancy can be terminated via by needle aspiration of the embryo while intrauterine pregnancy is effectively preserved.