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題名 | Pregnancy in a Previous Cesarean Section Scar: Case Report=前胎剖腹產傷口妊娠:病例報告 |
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作 者 | 黃寬慧; 李奇龍; 王錦榮; 宋永魁; 李錦輝; | 書刊名 | 長庚醫學 |
卷期 | 21:3 1998.09[民87.09] |
頁次 | 頁323-327 |
分類號 | 417.347 |
關鍵詞 | 前胎剖腹產傷口妊娠; 子宮外孕; 子宮切除; Cesarean section; Ectopic pregnancy; Hysterectomy; |
語文 | 英文(English) |
中文摘要 | 前胎剖腹產傷口妊娠是一種非常罕見的子宮外孕,因為診斷上非常困難,使得這 種型式的子宮外孕,成為子宮外孕中最危險的一種,而且常常危及病人的生命。我們提出這 個前胎剖腹產傷口妊娠的案例,是一位急診的病人,最後為了拯救病人的生命,施行子宮切 除手術。這是一位30歲的女性病人,到急診的主訴是陰道大量出血。這位病人曾於三個月前 因腎位懷孕而接受剖腹產手術。在急診時,我們使用超音波檢查發現,在子宮下緣有一懷孕 的囊胚,最初懷疑是漸進式的自然流產或是子宮頸懷孕。因為大量的陰道出血導致病人的生 命跡象不穩定,因此決定以手術方法來處理,以保住病人生命。首先我們先施行子宮內搔刮 手術,發現沒有懷孕的絨毛與囊胚,而且又持續地大量陰道出血,所以決定緊急剖腹探查, 最後因為流血不止而施行子宮切除手術。病理報告最後証實是「前胎剖腹產傷口妊娠」的診 斷。關於如何診斷、預防、臨床評估及處理這類異位妊娠的問題,仍然是一個有待探討的課 題。 |
英文摘要 | 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, surgicl 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. |
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