Hoshino Tatsuji, Miyamoto Taito, Yoshioka Shinya
Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Minami-Machi 2-1-1, Chuo-Ward, Kobe 650-0047, Japan.
Case Rep Obstet Gynecol. 2015;2015:685761. doi: 10.1155/2015/685761. Epub 2015 Sep 15.
In cases of fetal heartbeat- (FHB-) positive cesarean scar pregnancy (CSP), the embryo and placenta grow rapidly week by week. We experienced an FHB-positive CSP case at 6 weeks of gestation and assessed the CSP in detail with transvaginal ultrasound and transabdominal ultrasound (TAUS), preoperatively. We performed Laminaria cervical dilatation under TAUS guidance and performed hysteroscopic resection of the pregnancy conceptus and curettage under hysteroscopic and TAUS guidance. We identified the gestational sac attached to the cesarean scar pouch with small plane, decidua basalis, and chorionic villi and present the clinical history and other findings. We also reviewed the related literature and found 76 previous studies, with six cases of FHB-positive CSP that contained hysteroscopic color images of the CSP. We present a review of selected cases. The implantation site was the anterior wall in almost all cases. Cervical dilatation was mainly performed using a Hegar dilator; ours was the only case using Laminaria dilatation. Transcervical resections were performed mainly under ultrasound guidance, with only one case undergoing laparoscopy. Electrocoagulation was performed in three of the six cases.
在胎儿心跳（FHB）阳性的剖宫产瘢痕妊娠（CSP）病例中，胚胎和胎盘每周都迅速生长。我们遇到了一例妊娠6周时FHB阳性的CSP病例，并在术前通过经阴道超声和经腹超声（TAUS）对CSP进行了详细评估。我们在TAUS引导下进行了宫颈海藻棒扩张，并在宫腔镜和TAUS引导下进行了妊娠物的宫腔镜切除及刮宫术。我们识别出附着于剖宫产瘢痕憩室的妊娠囊，其具有小平面、基蜕膜和绒毛膜绒毛，并呈现了临床病史及其他发现。我们还回顾了相关文献，发现了76项先前的研究，其中有6例FHB阳性的CSP病例包含CSP的宫腔镜彩色图像。我们展示了所选病例的综述。几乎所有病例的着床部位均为前壁。宫颈扩张主要使用海格扩张器进行；我们的病例是唯一使用海藻棒扩张的。经宫颈切除术主要在超声引导下进行，只有1例接受了腹腔镜检查。6例中有3例进行了电凝术。
