Spitzer D, Steiner H, Graf A, Zajc M, Staudach A
Department of Gynaecology and Obstetrics, Landeskrankenanstalten Salzburg, Austria.
Hum Reprod. 1997 Apr;12(4):860-6. doi: 10.1093/humrep/12.4.860.
Recently, various conservative regimens for the treatment of cervical pregnancy have been introduced to preserve fertility in young women, with methotrexate being one of the most widely used drugs. The success of conservative treatment depends on early preoperative diagnosis. We report three cases of first trimester cervical pregnancy, successfully treated by curettage to evacuate the conceptus, followed by local prostaglandin instillation to prevent severe haemorrhage. In one patient, intra-amniotic instillation of hyperosmolar glucose was necessary to terminate fetal cardiac activity. beta-Human chorionic gonadotrophin returned to normal within 3 weeks in one patient and within 7 weeks in another, both of whom became pregnant again within 1 year, resulting in term deliveries. The third patient was lost to follow-up after 1 week. The advantage of prostaglandin and curettage is the absence of major side-effects to the mother or the fetus of a subsequent pregnancy. The management strategies used in the treatment of cervical pregnancies and the results obtained since the introduction of methotrexate in 1989 are discussed in the context of previously published literature. The incidence of subsequent pregnancies among women treated medically versus women treated surgically is reported.
最近，为了保留年轻女性的生育能力，已引入了各种保守治疗方案来治疗宫颈妊娠，甲氨蝶呤是使用最广泛的药物之一。保守治疗的成功取决于术前的早期诊断。我们报告了3例孕早期宫颈妊娠病例，通过刮宫清除妊娠物成功治疗，随后局部滴注前列腺素以防止严重出血。在1例患者中，需要羊膜腔内滴注高渗葡萄糖来终止胎儿心脏活动。1例患者的β-人绒毛膜促性腺激素在3周内恢复正常，另1例在7周内恢复正常，这2例患者均在1年内再次怀孕并足月分娩。第3例患者在1周后失访。前列腺素和刮宫的优点是对母亲或后续妊娠的胎儿没有重大副作用。结合先前发表的文献，讨论了宫颈妊娠治疗中使用的管理策略以及自1989年引入甲氨蝶呤以来所取得的结果。报告了接受药物治疗与手术治疗的女性后续妊娠的发生率。
