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腹腔镜处理残角子宫妊娠12周流产

Laparoscopic Management of a 12-Week Pregnancy Loss in a Rudimentary Uterine Horn.

作者信息

Srinivas Tara, Kirschen Gregory W, Yazdy Golsa M

机构信息

Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, USA.

出版信息

Cureus. 2024 Jun 4;16(6):e61677. doi: 10.7759/cureus.61677. eCollection 2024 Jun.

Abstract

Unicornuate uterus with rudimentary horn is a rare structural uterine anomaly resulting from incomplete Mullerian duct development and/or fusion. Pregnancy in rudimentary horn is an uncommon presentation of a Mullerian anomaly and may lead to substantial morbidity and mortality due to high risk of uterine rupture with intraabdominal hemorrhage. Medical and/or surgical management may be undertaken; however, currently, no treatment guidelines exist. We describe the management of a 12-week rudimentary horn pregnancy in a 25-year-old multiparous patient with a prior spontaneous preterm breech vaginal delivery and one spontaneous early term cephalic vaginal delivery in whom this congenital uterine condition was previously unknown. The rudimentary horn, nonviable pregnancy, and contiguous ipsilateral fallopian tube were excised laparoscopically without complication. Given the infrequency of rudimentary horn pregnancies and the high risk for obstetric complications, a high index of suspicion should be maintained. We emphasize that a history of preterm birth or malpresentation should raise suspicion for maternal Mullerian anomaly, and that a minimally invasive approach can be feasible for treatment of a rudimentary horn pregnancy.

摘要

残角子宫是一种罕见的子宫结构异常,由苗勒管发育不完全和/或融合所致。残角子宫妊娠是苗勒管异常的一种罕见表现,由于子宫破裂并腹腔内出血的风险高,可能导致严重的发病率和死亡率。可采取药物和/或手术治疗;然而,目前尚无治疗指南。我们描述了一名25岁经产妇的12周残角子宫妊娠的处理情况,该患者既往有一次自发性早产臀位阴道分娩和一次自发性足月头位阴道分娩,此前未知其患有这种先天性子宫疾病。通过腹腔镜切除了残角子宫、不可存活的妊娠物及相邻的同侧输卵管,无并发症发生。鉴于残角子宫妊娠罕见且产科并发症风险高,应保持高度的怀疑指数。我们强调,早产或胎位异常史应引起对母体苗勒管异常的怀疑,并且微创方法对于治疗残角子宫妊娠可能是可行的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871d/11223761/9656b38d0767/cureus-0016-00000061677-i01.jpg

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