Saito Kazuki, Fukami Maki, Miyado Mami, Ono Ichiro, Sumori Keijiro
Department of Molecular Endocrinology National Research Institute for Child Health and Development Tokyo Japan.
Department of Comprehensive Reproductive Medicine Graduate School Tokyo Medical and Dental University Tokyo Japan.
Reprod Med Biol. 2017 Oct 3;17(1):89-92. doi: 10.1002/rmb2.12064. eCollection 2018 Jan.
A 39-year-old woman presented with a genital hemorrhage at 5 weeks of gestation after an artificial cycle double frozen-thawed embryo transfer. She was diagnosed with a cervical heterotopic pregnancy. Although hormone supplementation was discontinued to terminate the pregnancy at 5 weeks of gestation, the intrauterine and cervical gestational sacs continued to develop.
The cervical gestational sac was surgically removed and the intrauterine pregnancy continued uneventfully, except for vasa previa. At 36 weeks of gestation, the patient underwent a cesarean section and gave birth to a healthy female infant. At the delivery, massive bleeding occurred and a hysterectomy was performed due to total placenta accreta.
This case provides a novel example of a near-term delivery after a cervical heterotopic pregnancy and emphasizes the need for intensive care, even after the successful management of a cervical pregnancy. Most importantly, the present case implies a possible link between hormonal withdrawal and abnormal placentation.
一名39岁女性在人工周期双冻融胚胎移植后妊娠5周时出现生殖器出血。她被诊断为宫颈异位妊娠。尽管在妊娠5周时停止补充激素以终止妊娠,但宫内和宫颈妊娠囊仍继续发育。
手术切除宫颈妊娠囊,除前置血管外,宫内妊娠继续顺利进行。妊娠36周时,患者接受剖宫产,产下一名健康女婴。分娩时发生大量出血,因完全性胎盘植入而行子宫切除术。
本病例提供了宫颈异位妊娠后近足月分娩的一个新例子,并强调即使宫颈妊娠成功处理后也需要重症监护。最重要的是,本病例暗示了激素撤退与胎盘植入异常之间可能存在联系。