Nadi M, Richard C, Filipuzzi L, Bergogne L, Douvier S, Sagot P
Service de gynécologie-obstétrique, centre hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France.
Service de gynécologie-obstétrique, médecine fœtale et reproduction humaine, CHU de Dijon, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
Gynecol Obstet Fertil Senol. 2017 Jun;45(6):340-347. doi: 10.1016/j.gofs.2017.05.002. Epub 2017 May 25.
Interstitial, angular and corneal pregnancies are not very frequent and often mistaken, each with its own definition and prognosis. The objective of this work is to relate 10 years experience of ectopic pregnancies at the UH in Dijon, based on the latest data from the literature in term of diagnosis, management and subsequent fertility.
This is a retrospective study carried out at the UH of Dijon from 01/01/2005 to 01/01/2015. From the medical records of each patient who presented a corneal, interstitial or angular pregnancy, we identified the risk factors for ectopic pregnancy (EG), the diagnostic and therapeutic means used, and the subsequent obstetrical events.
In 10 years, 532 EG were managed including 10 interstitials, one angular and nine cornual. The main risk factors were previous EG (50%), salpingectomy (55%), curettage (45%) and smoking (40%). The localization of the EG was done in 75% by the endo-vaginal sonography, in 25% in peroperative. Thirty-five percent were treated with methotrexate, 20% had surgery and 40% had both. Seventy-five percent of patients had at least one ulterior pregnancy. In the case of caesarean section, no dehiscence of the corneal scar was identified.
This study shows the presence of medical antecedents which are risk factors of the tubular EG. A methotrexate protocol should be proposed first. Even after corneal surgery, vaginal delivery may remain possible.
间质部、角部和宫颈妊娠并不常见,且常被误诊,它们各有其定义和预后。本研究旨在基于有关诊断、治疗及后续生育能力的最新文献数据,阐述第戎大学医院10年来异位妊娠的治疗经验。
这是一项在第戎大学医院开展的回顾性研究,时间跨度为2005年1月1日至2015年1月1日。从每例宫颈、间质部或角部妊娠患者的病历中,我们确定了异位妊娠(EG)的危险因素、所采用的诊断和治疗方法以及后续的产科事件。
10年间共处理了532例异位妊娠,其中间质部妊娠10例,角部妊娠1例,宫颈妊娠9例。主要危险因素为既往异位妊娠(50%)、输卵管切除术(55%)、刮宫术(45%)和吸烟(40%)。75%的异位妊娠通过经阴道超声定位,25%在术中定位。35%的患者接受甲氨蝶呤治疗,20%接受手术治疗,40%两者都采用。75%的患者至少有一次后续妊娠。剖宫产患者未发现宫颈瘢痕裂开。
本研究表明存在一些作为输卵管异位妊娠危险因素的病史。应首先推荐甲氨蝶呤治疗方案。即使接受了宫颈手术,仍有可能经阴道分娩。