Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University Federico II, Naples, Italy; Department of Advanced Biomedical Sciences, School of Medicine, University Federico II, Naples, Italy; Department of Public Health, University Federico II, Naples, Italy.
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University Federico II, Naples, Italy; Department of Advanced Biomedical Sciences, School of Medicine, University Federico II, Naples, Italy; Department of Public Health, University Federico II, Naples, Italy.
J Minim Invasive Gynecol. 2019 Jan;26(1):32-33. doi: 10.1016/j.jmig.2018.03.015. Epub 2018 Mar 27.
Angular pregnancy is a rare and life-threatening condition in which the embryo is implanted in the lateral angle of the uterine cavity, medial to the uterotubal junction and round ligament. Angular pregnancy is associated with a high risk of uterine rupture of about 23% [1]. No consensus has been achieved regarding the diagnostic and therapeutic approach of angular pregnancy [2]. Thus, the aim of this study was to report a case of hysteroscopic treatment of an angular pregnancy in a 34-year-old women.
Step-by-step video presentation of the surgical treatment (Canadian Task Force classification III).
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
A 34-year-old woman. Written informed consent was obtained from the patient.
Hysteroscopy.
A 34-year-old woman was admitted to our Department with pelvic pain at 6 weeks of gestation. β-Human chorionic gonadotropin (β-hCG) was 5331 mIU/mL. The transvaginal ultrasound showed a gestational sac of 15 × 11 mm in the left uterine angle of an embryo without cardiac activity. The woman opted for a conservative approach with multiple-dose methotrexate [3]. Five days later the β-hCG increased to 7589 mIU/mL with no regression of pregnancy at the transvaginal ultrasound. Therefore, a surgical approach was offered to the patient [4,5]. Laparoscopy showed normal salpinges, whereas hysteroscopy identified the gestational sac in the left uterine angle. A 5Fr bipolar electrode was used to open the gestational capsular decidua. The chorionic villi were progressively separated from the implantation site. Using grasping forceps we removed the specimen for histologic examination. Histologic examination confirmed the diagnosis of angular pregnancy. On the second postoperative day β-hCG was 1131 mIU/mL, and the patient was discharged the day after. At the 1-month follow-up visit, β-hCG and transvaginal ultrasound were negative for pregnancy. The office hysteroscopy showed an empty uterine cavity at 3-months' follow-up.
Our case shows that hysteroscopy may be used as a diagnostic and therapeutic tool for angular pregnancy, providing a unique image of the intact removal of the gestational sac.
子宫角妊娠是一种罕见的、危及生命的疾病，胚胎植入在子宫腔的侧角，位于输卵管-子宫连接处和圆韧带的内侧。子宫角妊娠与约 23%的子宫破裂风险相关[1]。对于子宫角妊娠的诊断和治疗方法尚未达成共识[2]。因此，本研究旨在报道一例 34 岁女性经宫腔镜治疗子宫角妊娠。
手术治疗的分步视频演示（加拿大工作队分类 III）。
那不勒斯费德里克二世大学神经科学、生殖科学与牙科系，那不勒斯，意大利。
一名 34 岁女性。患者签署了知情同意书。
宫腔镜检查。
一名 34 岁女性因孕 6 周时盆腔疼痛就诊于我院。β-人绒毛膜促性腺激素（β-hCG）为 5331 mIU/mL。经阴道超声显示子宫左侧角有一个 15×11mm 的孕囊，胚胎无胎心。该女性选择接受多剂量甲氨蝶呤[3]保守治疗。5 天后，β-hCG 升高至 7589 mIU/mL，经阴道超声未见妊娠消退。因此，向患者提供了手术治疗[4,5]。腹腔镜检查显示输卵管正常，而宫腔镜检查发现子宫左侧角有孕囊。使用 5Fr 双极电极打开妊娠囊蜕膜。绒毛从着床部位逐渐分离。使用抓钳取出标本进行组织学检查。组织学检查证实了子宫角妊娠的诊断。术后第 2 天，β-hCG 为 1131 mIU/mL，患者于术后第 2 天出院。在 1 个月的随访中，β-hCG 和经阴道超声均未见妊娠。在 3 个月的随访中，门诊宫腔镜检查显示子宫腔为空。
我们的病例表明，宫腔镜检查可作为子宫角妊娠的诊断和治疗工具，提供完整切除妊娠囊的独特图像。
