背景:非沟通性角妊娠(NCRHP)导致母亲和胎儿的生命危险。NCRHP的早期诊断和腹腔镜切除术对于预防灾难性疾病很重要。然而,延迟诊断到第二或第三个三个月,使得很难准确诊断NCRHP和双角子宫妊娠之间,因为这两种情况都表现为子宫破裂和大量腹膜出血。此外,这些罕见病例在妊娠试验中具有挑战性,并与后续妊娠的不良结局相关.
方法:一名31岁的gravida1para0韩国女性来到我们的不孕不育中心,经定时性交后尿液妊娠试验证实为阳性。在她被安排定时性交之前,在最初的不孕症检查中,根据超声扫描和子宫输卵管造影术,怀疑患有子宫右角非交通的单角子宫.在妊娠5周时,在右侧非沟通的基本角中观察到妊娠囊。血清β-人绒毛膜促性腺激素(b-hCG)水平为2052.0mIU/mL。选择性腹腔镜切除右角,包含一个孕囊,伴随着同侧输卵管切除术,进行无不良事件。经过3个月的恢复期和三个周期的概念试验,包括定时性交和宫腔内授精,使用拮抗剂方案进行体外受精(IVF),并确认成功怀孕。患者从妊娠21+6周到35+6周住院,接受了环扎术和用皮质类固醇治疗的保胎剂。她通过剖腹产分娩了一个早期男婴。
结论:在这种罕见的情况下,在腹腔镜下对NCRHP进行适当管理后,通过IVF成功妊娠,突显了NCRHP病例早期诊断和干预的重要性.及时识别和管理NCRHP对于预防灾难性疾病的发生和通过辅助生殖技术(ART)提高成功妊娠的预后至关重要。因此,对NCRHP的高度怀疑指数很重要,并采用了一系列诊断方法.
BACKGROUND: Non-communicating rudimentary horn pregnancy (NCRHP) lead to life-threatening condition for both mother and fetus. Early diagnosis of NCRHP and laparoscopic resection is important to prevent catastrophic conditions. However, delayed diagnosis until the second or third trimester makes it difficult to accurately diagnose between NCRHP and bicornuate uterine pregnancy, as both conditions present uterine rupture and massive hemoperitoneum. Furthermore, these rare cases are challenging in pregnancy trials and associated with adverse outcomes in subsequent pregnancies.
METHODS: A 31-year-old gravida 1 para 0 Korean woman visited our infertility center with a confirmed positive urine pregnancy test after timed intercourse. Before she was scheduled to have timed intercourse, a unicornuate uterus with a non-communicating right uterine horn was suspected based on an ultrasound scan and hysterosalpingography during the initial infertility workup. A gestational sac was observed in the right non-communicating rudimentary horn at 5 weeks of gestation. Serum beta-human chorionic gonadotropin (b-hCG) level was 2052.0mIU/mL. An elective laparoscopic resection of the right rudimentary horn containing a gestational sac, along with ipsilateral salpingectomy, was performed with no adverse event. After 3-month of recovery period and three cycles of conceptional trials involving timed intercourse and intrauterine insemination, in-vitro
fertilization (IVF) was performed using the antagonist protocol, and successful pregnancy was confirmed. The patient had been hospitalized from 21 + 6 weeks to 35 + 6 weeks of gestation, underwent cerclage placement and tocolytics with corticosteroid treatment. She delivered an early-term male baby by cesarean section.
CONCLUSIONS: In this rare
case, the successful pregnancy achieved through IVF following the appropriate management of NCRHP under laparoscopy underscores the critical importance of early diagnosis and intervention in cases of NCRHP. Timely identification and management of NCRHP are vital to prevent the occurrence of catastrophic conditions and to enhance the prognosis of a successful pregnancy through assisted reproductive technology (ART). Therefore, a high index of suspicion for NCRHP is important and employs a range of diagnostic modalities.