Analysis of cesarean scar pregnancy misdiagnosed case of lessons

Case report patients × ×, female, 24 years old. Because of the intermittent drug flow after curettage vaginal bleeding 18 days, a sudden increase in two hours "on November 23, 2011 15, 2012 45 hospitalized patients with the previous menstrual regularity, 13 years of age at menarche, 3-5 / 28-30 days, the amount of dysmenorrhea (-, G2P1, on February 2nd, 2012 pregnant full-term cesarean section, postoperative February vagina little bleeding five days thereafter menstrual been the next on November 3, 2012 due to nausea, fatigue, reaction, self-examination and urine HCG (+, our clinic line B-ultrasonic examination showed: intrauterine pregnancy (see enlarged uterus, about the size of 1.8 × 1.2 cm gestational sac anechoic intracapsular visible yolk sac, and then admitted to hospital, improve the relevant secondary inspection given after mifepristone tablets 150mg pm service at 8:30 on November 5 the misoprostol tablets 600ug Dayton clothing, medication After about half an hour abdominal pain and vaginal bleeding, close observation to 13:00 still no gestational sac discharge, in the patient's request to propofol phenol + fentanyl intravenous anesthesia curettage, surgery is not excessive harassment of the lower uterine segment incision site the scrapings tissue examination, see obvious villi and decidua, basically in line with the size of the B-surgery bleeding increased, about 50ml, immediate intravenous plus small pot 10u oxytocin reduce vaginal bleeding, patients safe return to the ward, to prevent infection treatment 3 days, improved and discharged patients after discharge, vaginal bleeding is less, a little brown discharge after November 10, daily use sanitary pads, was intermittent, abdominal pain, vagina meat tilting, a foamy outflow deny cough, hemoptysis, vaginal bleeding two hours in the pre-hospital sudden increase in dark red, accompanied by a blood clot, soaked underwear, then eager to come to our hospital, admitted to hospital, previously healthy vaginal bleeding of unknown origin? " hypertension, a history of heart disease, diabetes, kidney disease history, hepatitis, tuberculosis and other infectious diseases. denied history of trauma and drug allergies. admission examination: T37.5 ° C, P 96 beats / min, R20 / min, BP130 / 80mmHg. normal development, nutrition, moderate, independent posture, God Manchu language and interest. systemic yellowish discoloration of the skin and mucous membranes and bleeding points, not palpable superficial lymph nodes, heart and lung (-, soft abdomen, lower abdomen to see a cross-shaped stale scar does not touch mass, tenderness and rebound tenderness, liver and spleen ribs, shifting dullness (-, lower extremity edema. gynecological examination: vulvar married and non-type, see clot active bleeding, did not undergo invasive procedure Auxiliary examination: super B: the lower uterine segment at the endocervix hemorrhage (2.2 × 2.0cm slightly glare group the echo boundary less clear hint: the lower uterine segment at the endocervix hematocele. routine blood test showed WBC 6.5 × 10 * 9 / L, the HGB 141g / L, the the PT 14.1s APTT29.6s, liver and kidney function, blood glucose results normal admission diagnosis: vaginal bleeding of unknown origin: intrauterine residue? placenta accreta? incomplete uterine scar pregnancy abortion? trophoblastic disease? womb meningitis?, and to give the anti-infection, stop bleeding, promote uterine contractions, symptomatic treatment improved the blood βHCG November 26: 1579 mIU / mL, parallel color Doppler ultrasound examination shows abnormal echo within the uterus (cervix within the mouth, see a size of about 2.8 × 1.4cm hyperechoic border less clear. patients transferred to higher level hospitals in the the hysteroscopic downstream curettage on December 2, after diagnosis of incomplete abortion, uterine scar pregnancy bleeding 3-4 days clean, follow-up of 12 May 30 Menstruation, passing through three days clean. posted in the free papers Download Center http://eng.hi138.com
2 discussion cesarean scar pregnancy (cesarean scar pregnancy, CSP is a rare type of ectopic pregnancy, a special type of ectopic pregnancy, the fertilized egg, trophoblastic planting its preceding cesarean uterine scar Department [1] reported incidence of 0.45 ‰ [2], its pathogenesis may be due to cesarean discontinuity surgery can damage the wall of the uterus, the myometrium to the uterine cavity may form sinus when pregnant again, fecundity planted in the sinus, a cesarean scar pregnancy [3] In recent years, due to cesarean section increased significantly elevated incidence of uterine scar pregnancy, uterine scar pregnancy based on embryonic growth direction of the uterine cavity or to the grass-roots level, is divided into two types, type I: gestational sac planting defects cesarean incision scar on the uterus isthmus or intrauterine growth, may grow to live births, but greatly increase the risk of bleeding in the implant site, type II: gestational sac planted defects cesarean scar deep, immersed in the uterus grassroots even penetrate the wall of the uterus and bladder. auxiliary examination methods mainly rely on color Doppler ultrasound, MRI, endoscopic (hysteroscopy, laparoscopy, color Doppler ultrasound examination is the preferred diagnostic method, due to the lack of specificity of clinical manifestations, early onset of easily misdiagnosed as other diseases and give appropriate treatment, serious impact on the lives and health of women of childbearing age diseases. cesarean section patients after surgery less than a year, the antecedent B-abortion intrauterine pregnancy, ultrasound practitioners on is still a lack of awareness of the disease, the physician did not attract sufficient vigilance, routine drug flow and curettage, in fact, can cause life-threatening bleeding, but patients with a short time to pregnancy, painless curettage excessive harassment uterine scar site, so was not bleeding occurs residency cause alarm did not blind curettage avoid the serious consequences, when again hospitalized postoperative vaginal bleeding for a long time, and timely referral induced in patients with a good outcome. primary hospital clinicians should strengthen communication with ultrasound practitioners In particular, for pregnancy after cesarean section increased awareness, vigilance heart, early diagnosis, avoid blindly abortion, resulting in adverse consequences, and even endanger the patient's life.

References

[1] Fylstra DL, Pound-chang T, Miller MG, et al.Ectopic Pregnancy with-in a caesarean delivery scar: a review [J]. Obstet Gynecol Surv, 2002,57 (8) :537-543
[2] Seow KM, Huang LW, lin YH, et al.Cesarean scar pregnancy: issues in management [J]. Ultrasound Obstet Gynecol, 2004,2 (3) :247-253
[3] Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006 Jun; 107 (6): 1373-81 Links to free papers Download Center http://www. hi138.com

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