Faculty of Medical and Health Sciences, Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the School of Medicine, Tel Aviv University, 70300, Tel Aviv, Zerifin, Israel.
Arch Gynecol Obstet. 2024 Sep;310(3):1651-1657. doi: 10.1007/s00404-024-07642-8. Epub 2024 Jul 15.
The eccentric implantation of pregnancies in the upper lateral aspect of the uterine cavity is poorly defined clinically. The aim of the current study was to investigate whether differentiating between uterine anomalies that can lead to cavitary distortion has implications for the management of these pregnancies.
Eight cases of first-trimester eccentric pregnancy implantation within the endometrial cavity (study group) were retrospectively identified. For each woman in the study group, 10 women identified as having a first-trimester concentric pregnancy implantation during the first-trimester US examination were retrieved from our database (control group). After delivery or pregnancy demise, the presence of uterine anomalies was assessed by a 3D-US examination in all patients.
In the study group patients, an increased incidence of uterine anomalies (50.0% vs. 8.8%, p = 0.007) was found, compared to the controls. In the study group, the eccentric location persisted in half of the pregnancies (n = 4; 50%), whereas the other half migrated to a more centric location within the endometrial cavity (n = 4; 50%). The follow-up examination showed that all the early pregnancy demises occurred in cases where the pregnancy persisted at the eccentric location. Uterine malformations were also detected in all these cases.
The data point to a significantly higher incidence of uterine anomalies in patients diagnosed with eccentric pregnancy implantation within the endometrial cavity. These results advocate for the value of differentiating between eccentric pregnancies in non-anomalous versus anomalous uteri.
宫腔上部外侧的偏心性妊娠植入临床上定义不明确。本研究旨在探讨区分可能导致宫腔变形的子宫异常是否对这些妊娠的处理有影响。
回顾性分析了 8 例宫腔内早期偏心性妊娠植入（研究组）。在研究组中，每位患者均选择了 10 例在早期超声检查中被诊断为宫腔内同心妊娠植入的患者作为对照组。在所有患者分娩或妊娠终止后，通过 3D-US 检查评估子宫异常的存在情况。
与对照组相比，研究组患者子宫异常的发生率（50.0% vs. 8.8%，p=0.007）增加。在研究组中，有一半的偏心性位置持续存在（n=4；50%），而另一半则向宫腔内更中心的位置迁移（n=4；50%）。随访检查显示，所有早期妊娠终止均发生在妊娠持续在偏心位置的病例中。在所有这些病例中也检测到了子宫畸形。
数据表明，在被诊断为宫腔内偏心性妊娠植入的患者中，子宫异常的发生率明显更高。这些结果表明，区分非畸形和畸形子宫中的偏心性妊娠具有重要价值。
