CMH Lahore Medical College, Lahore, Pakistan.
National Hospital and Medical Centre, Lahore, Pakistan.
J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(4):702-703.
Angular ectopic is a rare form of ectopic pregnancy which is diagnosed as intrauterine pregnancy on ultrasound but may rupture in second trimester leading to maternal mortality. We present a case of a 32-year-old primigravida who presented at 18 weeks gestation to the emergency department of national hospital Lahore with complaint of dizziness, sweating and epigastric pain for one hour. She had an episode of diarrhoea and vomiting at hospital followed by rapidly increased abdominal distension and signs of hypovolemic shock. Urgent ultrasound suggested rupture of posterior uterine wall and massive hemoperitoneum. An urgent laparotomy was done. Uterus was perforated by pregnancy posteriorly. baby was inside the sac and alive. But died soon after birth. Uterus was repaired in two layers. Stepwise devascularization of uterus was done due to continuous bleeding. 6 units whole blood 6 FFP were transfused. The abnormal location of this pregnancy makes it antenatal diagnosis difficult. A high index of suspicion is needed in pregnant women presenting in shock even when intrauterine location of pregnancy is diagnosed in first trimester.
子宫角妊娠是一种罕见的异位妊娠形式，其在超声检查中被诊断为宫内妊娠，但可能在孕中期破裂，导致产妇死亡。我们报告了一例 32 岁初产妇的病例，她在妊娠 18 周时因头晕、出汗和上腹痛 1 小时到拉合尔国立医院急诊科就诊。她在医院出现腹泻和呕吐，随后腹部迅速膨胀，并出现低血容量休克的迹象。紧急超声提示子宫后壁破裂和大量血腹。立即进行了剖腹手术。妊娠部位穿透了子宫后壁。胎儿在囊内且存活。但出生后不久就死亡了。子宫被修复成两层。由于持续出血，逐步进行了子宫血管结扎。输注了 6 单位全血和 6 单位新鲜冷冻血浆。这种妊娠的异常位置使其产前诊断变得困难。即使在孕早期诊断出宫内妊娠，对于出现休克的孕妇也需要高度怀疑。
