Borton Zakk, Landon Alice G, Singh Savita
Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK.
Queen Alexandra Hospital, Portsmouth, Hampshire, UK.
BMJ Case Rep. 2015 Sep 30;2015:bcr2015211529. doi: 10.1136/bcr-2015-211529.
A 38-year-old woman presented with light vaginal bleeding at approximately 8 weeks gestation. Although she initially presented to accident and emergency with vaginal bleeding and menstrual-like pain, this rapidly settled and both symptoms resolved over the following days. An initial ultrasound scan revealed an empty uterus, with no adnexal masses or free fluid. Miscarriage was presumed. However, following suboptimal β-human chorionic gonadotropin decline, further ultrasonography noted a mass next to the right ovary. The patient underwent laparoscopy, revealing an ectopic pregnancy closely adherent to the peritoneum of the right pelvic wall. The patient was treated with systemic methotrexate and responded well. This rare form of ectopic pregnancy has a high maternal morbidity and mortality, and its optimal management is not definitively decided, due to the scarcity of the condition and subsequent lack of high-powered data. We present a case of successful medical management.
一名38岁女性在妊娠约8周时出现少量阴道出血。尽管她最初因阴道出血和类似月经的疼痛前往急诊，但这些症状很快缓解，随后几天两种症状均消失。初次超声扫描显示子宫内为空，无附件包块或游离液体。推测为流产。然而，在β-人绒毛膜促性腺激素下降不理想后，进一步超声检查发现右卵巢旁有一肿块。患者接受了腹腔镜检查，发现异位妊娠紧密附着于右盆腔壁腹膜。患者接受全身甲氨蝶呤治疗，反应良好。这种罕见的异位妊娠形式具有较高的孕产妇发病率和死亡率，由于该疾病罕见且随后缺乏有力数据，其最佳治疗方案尚未明确确定。我们报告一例成功的药物治疗病例。
