Hoshino Tatsuji, Kita Masato, Imai Yukihiro, Kokeguchi Shoji, Shiotani Masahide
Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan.
J Obstet Gynaecol Res. 2009 Dec;35(6):1115-20. doi: 10.1111/j.1447-0756.2009.01071.x.
It is difficult to treat cervical pregnancy without harming the intrauterine pregnancy. We report the case of a patient who was 37 years old and had an abdominal myomectomy. She had become pregnant by in vitro fertilization and egg transfer, and was transferred because of massive bleeding at 6 weeks of gestation. Afterwards, Escherichia coli infection was detected and intravenous antibiotics were administered. Careful intracervical mass reduction and curettage were performed under abdominal ultrasound guidance. The postoperative course was uneventful and she gave birth by cesarean section at 38 weeks. Sixteen cases exist in the literature. Treatment of cervical pregnancy was performed by KCl injection in six cases, hyperosmotic glucose injection in one and complete cervical evacuation in nine. The nine patients that had cervical evacuation delivered at term. In seven cervical mass preservation cases, one patient with twin pregnancy delivered at 34 weeks, and six with singletons delivered at 31-36 weeks. The best therapy is complete evacuation in early gestation in order to avoid infection, bleeding and premature birth. The authors emphasize abdominal ultrasound usage through the bladder window with 150-200 mL of water (or urine) for careful cervical mass reduction and curettage without harming the intrauterine pregnancy.
在不损害宫内妊娠的情况下治疗宫颈妊娠是困难的。我们报告一例37岁且行过腹部肌瘤切除术的患者。她通过体外受精和胚胎移植受孕，因妊娠6周时大量出血而转诊。此后，检测到大肠杆菌感染并给予静脉抗生素治疗。在腹部超声引导下仔细进行宫颈肿块缩小及刮宫术。术后过程顺利，她在38周时行剖宫产分娩。文献中有16例病例。其中6例通过氯化钾注射治疗宫颈妊娠，1例通过高渗葡萄糖注射治疗，9例通过完全清除宫颈内容物治疗。9例行宫颈清除术的患者足月分娩。在7例保留宫颈肿块的病例中，1例双胎妊娠患者在34周分娩，6例单胎妊娠患者在31 - 36周分娩。最佳治疗方法是在妊娠早期完全清除宫颈内容物，以避免感染、出血和早产。作者强调通过膀胱窗使用腹部超声，膀胱内注入150 - 200 mL水（或尿液），以便在不损害宫内妊娠的情况下仔细进行宫颈肿块缩小及刮宫术。
