宫角妊娠2例

Cornual pregnancy in 2 cases

宫角妊娠指受精卵种植在子宫与输卵管开口交界处的子宫角部,为罕见的异位妊娠,可引起各种并发症,最常见的是流产、子宫破裂和胎盘残留。由于宫角血供丰富,一旦发生子宫破裂常致大量出血,可能危及产妇生命。因其位置的特殊性,如果早孕期漏诊,至妊娠后期也极易漏诊、误诊。

Cornual pregnancy is one of the diseases caused by embryo embedment at abnormal site.Since few women with cornual pregnancy continue to a middle or late gestation are at a relatively increased risk of uterus rupture,placenta accrete,postpartum hemorrhage and some other severe obstetric complications. We reported two cases of cornual pregnancy at the third trimester,including their clinical symptoms,diagnoses,treatments and obstetric outcomes. Patient 1 had regular prenatal examination.The ultrasound scan at the second trimester showed that the placenta was located at the right fundus of uterus and the myometrium was thin. She had sudden-onset abdominal pain and hypovolemic shock at the end of 33 weeks of gestation. Emergency laparotomy revealed right cornual pregnancy rupture and delivered a dead fetus. After removing the residual gestational tissue and repairing the uterine defect,a live infant was born by cesarean section three years later. Patient 2 was found an unusually located placenta accreta at the right cornu when cesarean section was performed for twin pregnancy and pre-eclampsia.Conservative treatments were tried to reduce bleeding,such as strong contractive drugs,B-Lynch suture,bilateral ascending branch of uterine artery ligation,but they all failed. The patient developed to disseminated intravascular coagulation and had to accept hysterectomy at last. Through analysis of the above two cases and review of related literature,we explored the diagnoses and management of the patients with cornual pregnancy at the late trimester. Ultrasonography is essential to diagnose cornual pregnancy,especially at the early stage,and the abnormal images need special attention during the whole term. Besides magnetic resonance imaging is an alternative method to evaluate the location and placenta accrete. Since cornual pregnancy is always accompanied with placenta accrete,which tends to result in uncontrollable postpartum hemorrhage and increase maternal mortality,cesarean section is suggested once diagnosed and individualized treatment strategy is made according to specific circumstances,including age,bearing requirement,severity of the disease,underlying disease and so on. Therefore,adequate preparation is very important and necessary before surgery. Drugs and conservative surgeries should be considered first when hemorrhage happens,however,hysterectomy is the last method to save patients＇ lives when other treatment doesn＇t work.