Loukopoulos T, Zikopoulos A, Mastora E, Galani A, Stavros S, Kolibianakis E
University Hospital of Ioannina, Department of Obstetrics and Gynecology, Ioannina, Greece.
Obstetrics and Gynecology Royal Cornwall Hospital, Cornwall, UK.
Case Rep Womens Health. 2021 Dec 14;33:e00376. doi: 10.1016/j.crwh.2021.e00376. eCollection 2022 Jan.
An ectopic pregnancy, when the gestational sac is implanted outside of the uterine cavity, can be life-threatening. A cornual pregnancy is the most dangerous type of ectopic pregnancy since it can be misdiagnosed easily and has high mortality rate. It is diagnosed when the implantation site is at the junction between the fallopian tube and the uterus. For a successful outcome, early diagnosis and management are critical. The traditional management is surgical, involving cornual resection or hysterectomy, which, however, affects fertility. Thus, conservative management involving administration of methotrexate should always be considered.
The article describes to two women in their early forties with no previous children (G1, P0) and diagnosed with a cornual pregnancy at 7 and 8 weeks of gestation following in vitro fertilization. Given their hemodynamic stability and their desire to conserve fertility they were treated conservatively. The two patients had similar ultrasound findings and blood results. The main difference was the presence of an embryonic heart beat in one case. Successful management was accomplished with multidose methotrexate and leucovorin during hospitalization for 8 days and close monitoring for the next 30 days as outpatients. In addition, the second woman was given a transvaginal injection of potassium chloride (KCL) to stop embryonic cardiac activity.
Conservative management of cornual pregnancies applying multidose therapy of methotrexate and leucovorin is a safe treatment when patients are asymptomatic and preserves fertility.
异位妊娠是指妊娠囊着床于子宫腔外，可危及生命。宫角妊娠是最危险的异位妊娠类型，因为它容易被误诊且死亡率高。当着床部位在输卵管与子宫的交界处时可诊断为宫角妊娠。为取得成功的治疗效果，早期诊断和处理至关重要。传统的治疗方法是手术，包括宫角切除术或子宫切除术，但会影响生育能力。因此，应始终考虑采用甲氨蝶呤的保守治疗方法。
本文描述了两名四十出头、未曾生育过（孕1产0）的女性，她们在体外受精后妊娠7周和8周时被诊断为宫角妊娠。鉴于她们血流动力学稳定且希望保留生育能力，对她们进行了保守治疗。两名患者的超声检查结果和血液检查结果相似。主要区别在于其中一例有胚胎心跳。通过住院8天期间给予多剂量甲氨蝶呤和亚叶酸，并在接下来30天作为门诊患者进行密切监测，成功完成了治疗。此外，第二名女性接受了经阴道注射氯化钾（KCL）以停止胚胎心脏活动。
当患者无症状时，应用甲氨蝶呤和亚叶酸多剂量疗法对宫角妊娠进行保守治疗是一种安全的治疗方法，且能保留生育能力。
