误诊为宫内孕的宫颈妊娠11例临床分析

Clinical analysis of 11 cases of cervical pregnancy misdiagnosed as intrauterine pregnancy

目的总结误诊为宫内孕的宫颈妊娠病例临床与超声影像学特征,以提高临床医师对宫颈妊娠早期诊断的能力。方法回顾性分析2010年1月至2019年12月期间首都医科大学附属北京妇产医院生殖调节/计划生育科收治的11例误诊为宫内孕的宫颈妊娠患者生育史、专科查体、误诊前后的超声影像学特征及治疗结局。结果11例病例中已育者7例,其中有剖宫产史6例;9例有流产刮宫术史;误诊为宫内早孕6例,误诊为稽留流产3例,误诊为难免流产2例,其中误诊时行药物流产或刮宫术8例,4例出现大出血。9例行子宫动脉栓塞术;6例行宫腔镜明确诊断及手术;平均住院6 d,术后血β-人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)恢复正常中位时间为20 d。结论宫颈妊娠临床症状不典型,超声检查是主要的诊断依据,早期妊娠超声影像学提示是误诊主要原因,动态观察超声特征可帮助早期识别宫颈妊娠。

Objective To summarize the clinical characteristics of cervical pregnancy misdiagnosed as intrauterine pregnancy and improve the ability of clinicians in early diagnosis of cervical pregnancy.Methods Eleven cases of cervical pregnancy misdiagnosed as intrauterine pregnancy were retrospectively analyzed in Department of Reproductive Management in Beijing Obstetrics and Gynecology Hospital of Capital Medical University.Results Among the 11 patients,7 were fertile and 4 were infertile;9 cases had a history of abortion and curettage;6 cases were misdiagnosed as early intrauterine pregnancy,3 cases as delayed abortion,2 cases as inevitable abortion,among which 8 cases were misdiagnosed as medical abortion or curettage,and 4 cases had massive hemorrhage.Nine patients underwent uterine artery embolization.Six patients were definitely diagnosed and operated by hysteroscopy.The mean hospitalization was 6 d,and postoperativeβ-human chorionic gonadotropin(hCG)returned to normal for a median time of 20 d.Conclusion Clinical symptoms of cervical pregnancy are atypical,and ultrasound examination is the main diagnostic basis.Ultrasound imaging hints of early pregnancy are the main cause of misdiagnosis.Dynamic observation of ultrasonic signs can help to identify cervical pregnancy at early stage.