13周宫颈异位妊娠的成功保守治疗

Kadija S, Stefanovic A, Jeremic K, Radojevic M, Cerovic-Popovic R, Srbinovic M, Likic-Ladjevic I

Clin Exp Obstet Gynecol. 2016;43(2):291-3.

BACKGROUND

Cervical ectopic pregnancy is a potentially life-threatening condition due to the unexpected occurrence of uncontrollable bleeding from the cervix.

CASE REPORT

A 39-year-old secundigravida was admitted with amenorrhea of 12 weeks and four days due to suspected cervical pregnancy, without bleeding. The ultrasonography revealed a gestational sac at the anterior wall of the isthmic-cervical part with a single viable fetus, with crown-rump length (CRL) of 59 mm and regular heart rate. The serum β-human chorionic gonadotropin (β-hCG) level on admission was 143.416 mIU/l. Two possible therapeutic options were considered, (1) systemic methotrexate treatment and (2) uterine artery embolization with gelatine sponge. The first was rejected due to gestational age, viable fetus, high β-hCG level, and CRL, and the later was rejected by the vascular surgeons due to lack of experience. The curettage was performed. After the evacuation, prostin was administered into cervix accompanied with tamponade. On the next day β-hCG level was 44.342 mIU/l and the following day ultrasonography revealed the oval non-homogenous formation in the cervical cavity (blood clots or residual trophoblastic tissue); β-hCG level was 36.501 mIU/l. The reintervention was performed on the fifth day after the curettage and 200 ml of coagulated blood was aspirated; β-hCG level was 16.432 mlU/l. Since the isthmic-cervical part was slightly dilated (23 mm) seven days after the curettage, systemic methotrexate treatment (100 mg intramuscular) was initiated. Serum β-hCG level on the second and fourth day after methotrexate were 12.553 mIU/l and 8.900 mIU/l, respectively. The second dose of 100 mg of methotrexate was administered intramuscular seven days after the first dose. Three days after, β-hCG level was 2.329 U/l and ultrasound scan revealed normal isthmic-cervical finding.

CONCLUSION

The present case report showed efficient fertility sparing conservative treatment, dilatation and curettage, of 13 week cervical pregnancy followed by systemic methotrexate.

背景

宫颈异位妊娠是一种潜在的危及生命的疾病，因为宫颈可能会意外发生无法控制的出血。

病例报告

一名39岁经产妇因疑似宫颈妊娠伴停经12周零4天入院，无出血症状。超声检查显示在峡部-宫颈部前壁有一个妊娠囊，内有一个存活胎儿，头臀长（CRL）为59毫米，心率正常。入院时血清β-人绒毛膜促性腺激素（β-hCG）水平为143416 mIU/l。考虑了两种可能的治疗方案，（1）全身甲氨蝶呤治疗和（2）用明胶海绵进行子宫动脉栓塞。由于孕周、存活胎儿、高β-hCG水平和CRL，第一种方案被拒绝，而第二种方案因血管外科医生缺乏经验被拒绝。进行了刮宫术。刮宫后，将前列腺素注入宫颈并进行填塞。第二天β-hCG水平为44342 mIU/l，第三天超声检查显示宫颈管内有椭圆形不均匀回声团（血凝块或残留滋养层组织）；β-hCG水平为36501 mIU/l。刮宫术后第五天进行了再次干预，吸出200毫升凝血块；β-hCG水平为16432 mIU/l。由于刮宫术后七天峡部-宫颈部略有扩张（23毫米），开始进行全身甲氨蝶呤治疗（肌肉注射100毫克）。甲氨蝶呤治疗后第二天和第四天血清β-hCG水平分别为12553 mIU/l和8900 mIU/l。第一次给药七天后，肌肉注射第二次100毫克甲氨蝶呤。三天后，β-hCG水平为2329 U/l，超声检查显示峡部-宫颈部正常。