Sroussi Jérémy, Panchbhaya Nabilah, Boujlel Sihem, Dautry Raphaël, Tigaizin Ahmed, Benifla Jean-Louis
Department of Obstetrics and Gynecology, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Paris, France.
Department of Anesthesiology and Intensive Care, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Paris, France.
J Obstet Gynaecol Res. 2018 Sep;44(9):1824-1827. doi: 10.1111/jog.13707. Epub 2018 Jul 5.
We report a case of cesarean scar pregnancy at 16 weeks. Magnetic resonance imaging confirmed the isthmic ectopic location with an empty fundus and a high suspicion of placental invasion to the anterior myometrium. Because of pelvic pain, bleeding and the major risks of hysterectomy, a decision was made to terminate the pregnancy. After a preventive pelvic artery embolization, we performed an unusual posterior isthmic hysterotomy for the extraction of the fetus, followed by conservative management of the placenta. Bleeding loss was 300 mL, and no complication was reported. Successive magnetic resonance imaging was planned and 6 months later, there were no placental remnants. At 7 months, an office hysteroscopy revealed a normal uterine cavity. In case of cesarean scar pregnancy in the second trimester with an emergency need to interrupt pregnancy, posterior hysterotomy with conservative treatment of placenta may be an option to avoid massive bleeding and hysterectomy.
我们报告一例16周的剖宫产瘢痕妊娠病例。磁共振成像证实为峡部异位妊娠，子宫底部空虚，高度怀疑胎盘侵入子宫前壁肌层。由于盆腔疼痛、出血以及子宫切除的重大风险，决定终止妊娠。在进行预防性盆腔动脉栓塞后，我们采用了一种不寻常的后峡部子宫切开术来取出胎儿，随后对胎盘进行保守处理。失血300毫升，未报告并发症。计划进行后续磁共振成像检查，6个月后，未见胎盘残留。7个月时，门诊宫腔镜检查显示子宫腔正常。对于孕中期剖宫产瘢痕妊娠且急需终止妊娠的情况，后子宫切开术联合胎盘保守治疗可能是避免大出血和子宫切除的一种选择。
