社区医院如何识别与处理足月宫角妊娠

How to recognize and deal with full-term angular pregnancy in community hospitals

目的：探讨足月宫角妊娠的高危因素，产前如何识别与处理足月宫角妊娠，避免产科严重并发症的发生。方法2006年1月～2012年8月在我院分娩的孕妇3798例。对其中经剖宫产或剖腹探查术中明确诊断足月宫角妊娠的5例病例，及外院2005年5月1例足月宫角妊娠病例共6例病例进行回顾性分析。结果6例发生胎盘滞留，而且均发生在右侧子宫角部，4例以剖宫产结束分娩，1例阴道分娩后切除子宫；另1例阴道分娩后因胎盘滞留行剖宫产手术。5例产前或产后超声提示：胎盘位于子宫底后壁或右侧宫角；4例有人工流产史；2例阴道分娩后发生产后出血。结论足月宫角妊娠高危因素可能与人工流产手术导致的子宫内膜损伤有关，分娩最主要的并发症主要以胎盘滞留为首要并发症，多数以手术结束分娩。因此，产前及时识别宫角妊娠，选择合理的分娩方式，可以减少某些足月宫角妊娠并发症的发生，尽量保留患者的生育功能。

Objective To discuss the high risk factors of full-term angular pregnancy, as well as how to recognize and deal with full-term angular pregnancy, so as to avoid severe complications of antepartum period. Methods 3798 cases of pregnant women finished childbirth in our hospital from January 1st, 2006 to August 30th, 2012. We launched a retrospective analysis on the 6 women who had full-term angular pregnancy diagnosed by cesarean delivery or abdominal laparotomy,of which 5 are patients in our own hospital and 1 from another hospital. Results 6 of the patients had mazischesis, who all had angular pregnancy on the right uterine horn. 4 of them finished childbirth with cesarean delivery, and 1 of them accepted hysterectomy after vaginal delivery, other 1 of them accepted exploratory laparotomy after vaginal delivery, becase mazischesis. The placentas of 5 patients were at fundus uteri paries posterior or dextral cornu uteri showed by ultrasound. 4 patients had induced abortion history. 2 patients suffered postpartum hemorrhage after vaginal delivery. Conclusion The high risk of full-term angular pregnancy may include endometria injury caused by artificial abortion operation. The main complication of full-term angular pregnancy during parturition is mazischesis, and most of them finish childbirth by surgery. Therefore, timely diagnosis of comual pregnancy and appropriate delivery mode can reduce the incidence of complication of angular pregnancy and may well keep the fertility ability of patients.