Sampson Victoria, Mogekwu Oluremi, Ahmed Ammar, Bano Farida
Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK.
Case Rep Obstet Gynecol. 2017;2017:6391849. doi: 10.1155/2017/6391849. Epub 2017 Sep 27.
Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART). Ultrasound (USS) and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation.
异位妊娠发生率为妊娠总数的1%-2%。输卵管是最常见的发病部位；然而，双侧输卵管异位妊娠极为罕见，约20万次妊娠中仅见1例。其通常是辅助生殖技术（ART）的结果。超声（USS）和连续检测β-人绒毛膜促性腺激素（β-hCG）水平对准确诊断的效果不佳。腹腔镜检查是诊断的金标准。大多数病例采用双侧输卵管切除术进行手术治疗。一名26岁女性在体外受精（IVF）后妊娠5周时因腹痛和阴道出血就诊于我院早期妊娠科。超声检查结果不明确，且随着疼痛加剧其β-hCG水平升高；因此，决定进行诊断性腹腔镜检查。尽管右侧有明确的异位妊娠，但左侧输卵管肿胀，因此进行了亚甲蓝染色试验以确认阻塞情况。通过无创伤性挤压以暴露染料时，排出了坏死组织，组织学检查证实为另一例异位妊娠。随着β-hCG水平下降，她恢复良好，左侧输卵管得以保留。随着辅助生殖技术使用的增加，双侧异位妊娠将变得更为常见。应采用新的和已有的技术来帮助确诊并协助保留输卵管。
