Wang S, Zhang Y, Zhao Y Y, Lu S
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Jun 18;50(3):576-579.
Cornual pregnancy is one of the diseases caused by embryo embedment at abnormal site. Since few women with cornual pregnancy continue to a middle or late gestation are at a relatively increased risk of uterus rupture,placenta accrete,postpartum hemorrhage and some other severe obstetric complications. We reported two cases of cornual pregnancy at the third trimester, including their clinical symptoms, diagnoses, treatments and obstetric outcomes. Patient 1 had regular prenatal examination. The ultrasound scan at the second trimester showed that the placenta was located at the right fundus of uterus and the myometrium was thin. She had sudden-onset abdominal pain and hypovolemic shock at the end of 33 weeks of gestation. Emergency laparotomy revealed right cornual pregnancy rupture and delivered a dead fetus. After removing the residual gestational tissue and repairing the uterine defect, a live infant was born by cesarean section three years later. Patient 2 was found an unusually located placenta accreta at the right cornu when cesarean section was performed for twin pregnancy and pre-eclampsia. Conservative treatments were tried to reduce bleeding, such as strong contractive drugs, B-Lynch suture,bilateral ascending branch of uterine artery ligation, but they all failed. The patient developed to disseminated intravascular coagulation and had to accept hysterectomy at last. Through analysis of the above two cases and review of related literature, we explored the diagnoses and management of the patients with cornual pregnancy at the late trimester. Ultrasonography is essential to diagnose cornual pregnancy, especially at the early stage, and the abnormal images need special attention during the whole term. Besides magnetic resonance imaging is an alternative method to evaluate the location and placenta accrete. Since cornual pregnancy is always accompanied with placenta accrete, which tends to result in uncontrollable postpartum hemorrhage and increase maternal mortality, cesarean section is suggested once diagnosed and individualized treatment strategy is made according to specific circumstances, including age, bearing requirement, severity of the disease, underlying disease and so on. Therefore, adequate preparation is very important and necessary before surgery. Drugs and conservative surgeries should be considered first when hemorrhage happens, however, hysterectomy is the last method to save patients' lives when other treatment doesn't work.
宫角妊娠是胚胎着床于异常部位所导致的疾病之一。由于很少有宫角妊娠的女性能持续至中晚期，她们发生子宫破裂、胎盘植入、产后出血及其他严重产科并发症的风险相对增加。我们报道了两例妊娠晚期宫角妊娠病例，包括其临床症状、诊断、治疗及产科结局。病例1进行了常规产前检查。孕中期超声检查显示胎盘位于子宫右底部，子宫肌层较薄。孕33周末，她突然出现腹痛及低血容量休克。急诊剖腹探查发现右宫角妊娠破裂，娩出一死胎。清除残留妊娠组织并修复子宫缺损后，三年后经剖宫产娩出一活婴。病例2因双胎妊娠合并子痫前期行剖宫产时，发现右宫角胎盘植入异常。尝试了多种保守治疗方法以减少出血，如使用强效宫缩药物、B-Lynch缝合、双侧子宫动脉上行支结扎，但均失败。患者发展为弥散性血管内凝血，最终不得不接受子宫切除术。通过对上述两例病例的分析及相关文献复习，我们探讨了妊娠晚期宫角妊娠患者的诊断及处理。超声检查对于诊断宫角妊娠至关重要，尤其是在早期，整个孕期都需特别关注异常图像。此外，磁共振成像也是评估病变位置及胎盘植入情况的一种替代方法。由于宫角妊娠常伴有胎盘植入，易导致难以控制的产后出血并增加孕产妇死亡率，一旦确诊建议行剖宫产，并根据年龄、生育需求、疾病严重程度、基础疾病等具体情况制定个体化治疗策略。因此，手术前充分准备非常重要且必要。出血时应首先考虑药物及保守手术治疗，然而，当其他治疗无效时，子宫切除术是挽救患者生命的最后手段。
