Huang K H, Lee C L, Wang C J, Soong Y K, Lee K F
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Changgeng Yi Xue Za Zhi. 1998 Sep;21(3):323-7.
An ectopic pregnancy developing in a previous cesarean section scar is an extreme rarity among all ectopic pregnancies. Due to the difficulty of making an accurate diagnosis, this kind of ectopic pregnancy is the most dangerous and life-threatening type. A 30-year-old woman, who was gravida 4, para 3, was admitted to our emergency room with massive vaginal bleeding. She had undergone a cesarean section due to a breech birth 3 months prior to this admission. Ultrasound examination showed a pregnancy located in the low corpus uterus. The possibility of a spontaneous abortion in progress or a cervico-isthmic pregnancy were considered. Due to the massive vaginal bleeding and unstable vital signs of the patient, surgical intervention was decided upon to save the woman's life. We first performed dilatation and curettage. There was no gestational villi and severe vaginal bleeding was noted during this procedure. An emergent exploratory laparotomy was then performed, followed finally by a hysterectomy. Pathologic findings confirmed the diagnosis of a pregnancy in the previous cesarean section scar. Diagnosis, prevention, clinical evaluation and management of these conditions are discussed.
剖宫产瘢痕部位发生的异位妊娠在所有异位妊娠中极为罕见。由于准确诊断困难，此类异位妊娠是最危险且危及生命的类型。一名30岁经产妇（孕4产3）因大量阴道出血被送入我院急诊室。此次入院前3个月她因臀位分娩行剖宫产术。超声检查显示妊娠位于子宫体下段。考虑了难免流产或宫颈峡部妊娠的可能性。由于患者大量阴道出血且生命体征不稳定，决定进行手术干预以挽救患者生命。我们首先进行了刮宫术。术中未见妊娠绒毛且有严重阴道出血。随后进行了急诊剖腹探查术，最终行子宫切除术。病理检查结果证实为既往剖宫产瘢痕部位妊娠。文中讨论了这些情况的诊断、预防、临床评估及处理。
