Saeng-anan Ubol, Sreshthaputra Opas, Sukpan Kornkanok, Tongsong Theera
Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand.
BMJ Case Rep. 2013 Aug 8;2013:bcr2013200440. doi: 10.1136/bcr-2013-200440.
This report describes a catastrophic bleeding following methotrexate treatment of cervical pregnancy and dramatic response to Bakri surgical obstetric silicone (SOS) balloon tamponade in controlling massive bleeding. A 42-year-old woman was diagnosed for cervical pregnancy with a viable fetus at 12 weeks by transvaginal ultrasound. Conservative treatment with intrafetal potassium chloride injection and systemic methotrexate were instituted. On the sixth day of therapy, catastrophic bleeding lead to hypovolemic shock. After resuscitation and blood transfusion, we attempt to control the bleeding with evacuation and curettage but was unsuccessful. Bakri SOS balloon tamponade was applied with immediate and effective response. Nevertheless, total abdominal hysterectomy was performed. In conclusion, conservative treatment of cervical pregnancy with systemic methotrexate could be catastrophic in some patients. Control of active bleeding with Bakri SOS balloon tamponade may possibly be helpful in case of uncontrolled bleeding in selected cases.
本报告描述了甲氨蝶呤治疗宫颈妊娠后发生的灾难性出血，以及Bakri产科手术硅胶（SOS）球囊填塞术在控制大出血方面的显著效果。一名42岁女性经阴道超声诊断为宫颈妊娠，孕12周，胎儿存活。采用胎儿内氯化钾注射和全身甲氨蝶呤进行保守治疗。治疗第6天，灾难性出血导致低血容量性休克。复苏和输血后，我们试图通过刮宫术控制出血，但未成功。应用Bakri SOS球囊填塞术，立即取得了有效反应。尽管如此，仍进行了全腹子宫切除术。总之，对某些患者而言，全身应用甲氨蝶呤保守治疗宫颈妊娠可能会带来灾难性后果。在特定病例中，若出血无法控制，使用Bakri SOS球囊填塞术控制活动性出血可能会有所帮助。
