Finlinson Alex R, Bollig Kassie J, Schust Danny J
Department of Obstetrics, Gynecology and Women's Health, MU Institute for Women's Health Research, University of Missouri School of Medicine, 500 North Keene Street, Columbia, MO 65201 USA.
Fertil Res Pract. 2020 May 4;6:8. doi: 10.1186/s40738-020-00077-0. eCollection 2020.
Eccentrically located intracavitary pregnancies, which include pregnancies traditionally termed as cornual and/or angular, have long presented complex diagnostic and management challenges given their inherent relationship to interstitial ectopic pregnancies. This review uses the existing literature to discriminate among interstitial, cornual, and angular pregnancies. Current arguments propose the outright abandonment of the terms cornual and angular may be justified in favor of the singular term, eccentric pregnancy. Disparate definitions and diagnostic approaches have compromised the literature's ability to precisely describe prognosis and ideal management practices for each of these types of pregnancies. Standardizing the classification of these pregnancies near the uterotubal junction is important to unify conservative, yet safe and effective management strategies. We advocate the use of early first trimester ultrasound to correctly differentiate between eccentric pregnancy and interstitial ectopic pregnancy as current research suggests substantially better outcomes with correctly diagnosed and expectantly managed eccentric pregnancies than past investigations may have shown. The expectant management of eccentric pregnancies will often result in a healthy term pregnancy, while interstitial ectopic pregnancies inherently have a poor likelihood of progressing to viability. When the terms and diagnosis of cornual, angular, and interstitial pregnancy are indistinct, there is substantial risk of intrauterine pregnancies to be inappropriately managed as ectopic pregnancies. Until we standardize terms and criteria, it will remain difficult, if not impossible, to determine true risk for pregnancy loss, preterm labor, abnormal placentation, and uterine or uterotubal rupture. The development of best practice guidelines will require standardized terminology and diagnostic techniques.
偏心腔内妊娠，包括传统上称为宫角妊娠和/或角部妊娠，由于其与间质部异位妊娠的内在关系，长期以来一直存在复杂的诊断和管理挑战。本综述利用现有文献来区分间质部妊娠、宫角妊娠和角部妊娠。目前的观点认为，完全摒弃宫角妊娠和角部妊娠这两个术语，而采用单一的偏心妊娠术语可能是合理的。不同的定义和诊断方法损害了文献精确描述这些类型妊娠的预后和理想管理方法的能力。规范子宫输卵管交界处附近这些妊娠的分类对于统一保守但安全有效的管理策略很重要。我们提倡在孕早期使用超声来正确区分偏心妊娠和间质部异位妊娠，因为目前的研究表明，与过去的研究相比，正确诊断并进行期待治疗的偏心妊娠的结局要好得多。偏心妊娠的期待治疗通常会导致足月健康妊娠，而间质部异位妊娠本身进展为活产的可能性很小。当宫角妊娠、角部妊娠和间质部妊娠的术语和诊断不明确时，宫内妊娠被不当作为异位妊娠处理的风险很大。在我们规范术语和标准之前，确定妊娠丢失、早产、胎盘异常和子宫或子宫输卵管破裂的真正风险将仍然很困难，甚至不可能。最佳实践指南的制定将需要标准化的术语和诊断技术。
