Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China; Department of Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China.
Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
Fertil Steril. 2023 Nov;120(5):1079-1080. doi: 10.1016/j.fertnstert.2023.07.021. Epub 2023 Jul 28.
To introduce a case of removing heterotopic cervical pregnancy while preserving the normal gestational sac in the uterine cavity by hysteroscopic surgery under ultrasound guidance.
Video description of the case and surgical procedure.
Hospital affiliated to a university.
A 35-year-old woman with G7P1A5L1 was admitted with a heterotopic cervical pregnancy 21 days after in vitro fertilization and embryo transfer (the corrected gestational age was 5 weeks). The serum β-human chorionic gonadotropin level was 24,530 mIU/mL at the corrected gestational age of 5 weeks. Ultrasound examination on the day of admission showed that there was a gestational sac in the cervical canal (1.5 × 0.8 × 0.5 cm, yolk sac visible) and another in the intrauterine cavity (1.2 × 1.2 × 1.1 cm, yolk sac visible). The pregnant woman and her partner strongly urged to remove the cervical gestational sac and continue the intrauterine pregnancy to term.
After the Institutional Review Board approval was obtained, hysteroscopic surgery with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the heterotopic cervical pregnancy while preserving the intrauterine gestational sac.
The heterotopic cervical pregnancy was completely resected by hysteroscopy, and the normal gestational sac in the uterine cavity was successfully preserved.
Ultrasound-guided hysteroscopic surgery allowed us to successfully preserve the intrauterine pregnancy while removing the cervical pregnancy completely. During the operation, the dilation pressure and the flow rate of the dilation fluid was kept as low as possible to avoid excessive intrauterine pressure and excessive dilation fluid entering the intrauterine cavity, which could have had adverse effects on the intrauterine pregnancy sac. No surgical- or anesthesia-related complications occurred. The pathological results confirmed placental villi and decidual tissue. The one-month follow-up ultrasonography showed a live single intrauterine pregnancy with cardiac activity.
CONCLUSION(S): Hysteroscopic removal of a heterotopic cervical pregnancy under ultrasound guidance can be safely performed while successfully preserving an ongoing intrauterine pregnancy.
介绍在超声引导下经宫腔镜手术切除异位宫颈妊娠同时保留宫腔内正常妊娠囊的病例。
病例和手术过程的视频描述。
大学附属医院。
一名 35 岁 G7P1A5L1 患者，行体外受精-胚胎移植术后 21 天（校正孕周 5 周）时诊断为异位宫颈妊娠。校正孕周 5 周时，血清β-人绒毛膜促性腺激素水平为 24530 mIU/mL。入院当天的超声检查显示宫颈管内有妊娠囊（1.5×0.8×0.5 cm，可见卵黄囊），宫腔内也有妊娠囊（1.2×1.2×1.1 cm，可见卵黄囊）。患者及其配偶强烈要求切除宫颈妊娠囊并继续宫内妊娠至足月。
在获得机构审查委员会批准后，采用宫腔镜联合双极电切镜和经腹超声引导，切除异位宫颈妊娠，同时保留宫腔内妊娠囊。
完全经宫腔镜切除异位宫颈妊娠，成功保留宫腔内正常妊娠囊。
超声引导下宫腔镜手术成功切除宫颈妊娠，同时完全保留宫内妊娠。手术过程中，扩张压力和扩张液流速保持尽可能低，以避免宫腔内压力过高和过多的扩张液进入宫腔，对宫内妊娠囊造成不良影响。无手术或麻醉相关并发症发生。病理结果证实为胎盘绒毛和蜕膜组织。术后 1 个月随访超声显示宫内单活胎，有胎心搏动。
在超声引导下经宫腔镜切除异位宫颈妊娠可安全进行，同时成功保留正在进行的宫内妊娠。
