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Rizk观点:宫颈妊娠和剖宫产瘢痕妊娠的诊断和治疗

  中国育龄夫妇的不孕不育率从20年前的2.5%-3%攀升到近年12%-15%左右不孕不育者约5000万在生育路上大家或多或少都会遇到一些难题今天我们翻译了CEF大咖——美国试管婴儿教父Rizk教授

  关于宫颈妊娠和剖宫产瘢痕妊娠的诊断和治疗

  美国试管婴儿教父Botros Rizk,M.D,作为CFG全球医疗总监,同时也是CEF创始人、院长。他师从诺贝尔奖得主试管婴儿之父Robert Edwards,有40年执业从医经验,参与过10000+试管案例。

  Title:Cervical and Cesarean scar ectopic pregnancies: Diagnosis and management

  This study analyzes the diagnosis and management of two types of risky pregnancies, that is, cervical and Cesarean scar pregnancies (SCP). While Cervical pregnancies are very rare in naturally conceived pregnancies and in assisted reproductive technology, SCP are more commonly seen today as a result of a significant increase in the proportion of Cesarean deliveries over the last three decades.

  Though they are relevantly rare to occur among pregnancies, they will cause significant morbidity or even worse, to mortality, thus early diagnosis and management are of essence. Advanced ultrasonography will make it more precisely to identify cervical pregnancies and SCP. Early diagnosis permits more successful usage of a protocol.

  In this study, the diagnosis technology by using ultrasonography is also illustrated.

  There are quite a number of options for managing cervical pregnancies and SCP. The specific management should be based on the patient’s condition and expectation. The chemotherapy with methotrexate is the most successful treatment in cervical pregnancies. However, a standard protocol is still absent for SCP.

  Rizk教授分析了两类比较严重的异常妊娠:宫颈妊娠和剖宫产瘢痕妊娠。宫颈妊娠在自然妊娠和辅助生殖移植中极少发生,剖宫产瘢痕妊娠因为近三十年来剖宫产手术增加而有所增加。

  尽管这两类妊娠在所有怀孕案例中相对比较少发生,但是它们有比较高的病发症,严重情况下可能致死。所以提前诊断和治疗非常重要。先进的B超技术能提高宫颈妊娠和剖宫产瘢痕妊娠的确诊率。提前诊断也能提高治疗方案的成功率。

  Rizk教授还介绍了B超技术在这两类妊娠诊断中的应用。

  目前针对这两类妊娠,有几种治疗办法。针对相关病例的治疗方案应当根据患者的情况和患者的意愿来制定。宫颈妊娠常用药物甲氨蝶呤进行治疗。

  B超可见滋养层细胞侵入宫颈内口

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  备注:

  Cervical pregnancy is an ectopic pregnancy in which the fetus and placenta implant in the cervix.

  Cesarean scar pregnancy is a pregnancy within a previous CS scar.

  宫颈妊娠是指胎儿和胎盘着位于宫颈内的异位妊娠。

  剖宫产瘢痕妊娠(CSP)是指妊娠的着位点在原来的剖宫产瘢痕上的妊娠。是一种特殊的异位妊娠。10余年,随着剖宫产率的逐年增加,CSP发病呈上升趋势。若CSP患者未能得到及早诊断和恰当处理,则可能发生严重出血,甚至可能切除子宫,严重者危及生命,给妇女造成严重的健康损害。如果CSP继续妊娠至中晚期,则发生胎盘植入、腹腔妊娠、子宫破裂及出血的风险大大增加。

  Managemen

  治疗方案:

  For cervical pregnancies: curettage and local prostaglandin injection, hysteroscopic resection, angiographic UAE, uterine artery ligation and cervicotomy,intracervical injections of vasoconstructive agents etc.

  For CSP: local or systemic methotrexate injections, laparoscopic aspiration of the gestational sac, UAE alone or UAE with local methotrexate etc.

  针对宫颈妊娠:切除术和局部前列腺素注射治疗,宫腔镜切除术,血管造影子宫动脉栓塞、术,子宫动脉结扎,宫颈切除术,宫颈内血管收缩剂注射治疗等。

  针对宫腔瘢痕妊娠:局部或系统性甲氨蝶呤注射治疗,腹腔镜下抽吸孕囊手术,子宫动脉栓塞术,或者子宫动脉栓塞术结合局部甲氨蝶呤注射治疗等。