Lam Po Mui, Lo Keith Wing Kit
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
J Reprod Med. 2002 Apr;47(4):332-4.
Pregnancy developing in a cesarean section scar is a very rare but possibly life-threatening condition because of the risk of rupture and excessive hemorrhage.
A woman with previous cesarean section had transvaginal sonography performed at 7 weeks of gestation that showed a gestational sac implanted in the anterior isthmus wall of the uterus with 3 mm of myometrium between the sac and bladder wall. A diagnosis of pregnancy in the cesarean section scar was made. The patient was asymptomatic, and her hemodynamic condition was stable. Two courses of multiple-dose systemic methotrexate-folinic acid (1 mg/kg methotrexate intramuscularly on days 1, 3, 5 and 7 with 0.1 mg/kg folinic acid intramuscularly on days 2, 4, 6 and 8) were given. The patient tolerated it and remained stable during treatment. The serum hCG dropped to < 5 IU/L on day 56.
Treatment with methotrexate is a non-surgical option that can improve preservation of the uterus in patients who desire fertility. A multiple-dose regimen causes rapid interruption of the pregnancy. This is very important because the risk of rupture and hemorrhage directly correlates with the duration of the pregnancy.
剖宫产瘢痕部位妊娠是一种非常罕见但可能危及生命的情况，因为存在子宫破裂和大出血的风险。
一名有剖宫产史的女性在妊娠7周时接受经阴道超声检查，结果显示妊娠囊植入子宫前峡部壁，妊娠囊与膀胱壁之间有3毫米的肌层。诊断为剖宫产瘢痕部位妊娠。患者无症状，血流动力学状况稳定。给予两疗程多剂量甲氨蝶呤-亚叶酸治疗（第1、3、5和7天肌肉注射甲氨蝶呤1毫克/千克，第2、4、6和8天肌肉注射亚叶酸0.1毫克/千克）。患者耐受良好，治疗期间病情稳定。第56天时血清人绒毛膜促性腺激素降至<5 IU/L。
甲氨蝶呤治疗是一种非手术选择，对于有生育意愿的患者可提高子宫保留率。多剂量方案可迅速终止妊娠。这非常重要，因为子宫破裂和出血的风险与妊娠持续时间直接相关。
