■为了提高对卵巢诱导患者妊娠和异位妊娠发生率增加的认识,他们隐匿的腹痛症状,贫血,妊娠早期血流动力学不稳定,以及经阴道超声(TVUS)和定量β人绒毛膜促性腺激素(b-hCG)对诊断的有用性。
■卓越,排卵的发生,受精,在正在进行的妊娠和异位妊娠(HP)期间,同时存在宫内和宫外妊娠是罕见的现象。我们报告了一个两者共存的案例,诊断和管理方面的挑战以及与辅助生殖技术(ART)的广泛使用的关联。一个32岁的女人,以前接受过排卵诱导治疗的人,根据她的最后一次月经期,在怀孕8周时出现腹痛。患者具有高定量的血清β-人绒毛膜促性腺激素(b-hCG)(30,883mIU/mL)。她非常稳定,没有贫血。经阴道超声(TVUS)显示两次不同胎龄的妊娠:5周和3天的宫内妊娠,10周零5天时右侧完整的输卵管异位妊娠。然后诊断出导致HP的过度。随后,患者接受了右腹腔镜输卵管切除术。宫内妊娠进展正常,结果在38周时通过剖宫产分娩健康的足月新生儿。在怀孕期间,由于抑制卵泡发育和排卵,通常很少见。已经提出了各种理论来解释其病因,包括多排卵,延迟胚泡着床,雌激素异常和b-hCG激增。在超级胎儿中,由先前的受孕产生的胚胎与另一个胚胎共存,要么是子宫内,导致胎龄明显不同的双卵双胞胎,或子宫外导致HP。尽管诊断特别具有挑战性,因为它的症状可能与妊娠早期其他更常见的临床症状重叠,HP越来越多地出现在ART中。此外,HP的治疗是通用的,从预期管理到腹腔镜手术。对HP和胎儿过度的高度怀疑对患者至关重要,在ART之后,出现腹痛,血流动力学不稳定,或贫血。此外,计划接受后续ART周期的患者应采用b-hCG和TVUS进行全面筛查,以排除正在进行的宫内或宫外妊娠.
UNASSIGNED: To raise awareness about the increasing incidence of
superfetation and heterotopic pregnancy in patients with ovarian induction, their insidious symptoms of abdominal pain, anemia, and hemodynamic instability in early pregnancy, and the usefulness of transvaginal ultrasound (TVUS) and quantitative beta human chorionic gonadotrophin (b-hCG) for diagnosis.
UNASSIGNED: Superfetation, occurrence of ovulation, fertilization, and implantation during an ongoing pregnancy and heterotopic pregnancy (HP) simultaneous presence of intrauterine and extrauterine pregnancies are infrequent phenomena. We report a case where both coexisted, challenges in diagnosis and management and association with the widespread use of assisted reproductive technologies (ARTs). A 32-year-old woman, who previously underwent ovulation induction therapy, presented with abdominal pain at 8 weeks pregnancy according to her last menstrual period. The patient had high quantitative serum beta-human chorionic gonadotropin (b-hCG) (30,883 mIU/mL). She was vitally stable and not anemic. Transvaginal ultrasound (TVUS) revealed two pregnancies at different gestational ages: an intrauterine pregnancy at 5 weeks and 3 days, and a right intact tubal ectopic pregnancy at 10 weeks and 5 days.
Superfetation resulting in HP was then diagnosed. Subsequently, the patient underwent right laparoscopic salpingectomy. The intrauterine pregnancy progressed normally, resulting in delivery of a healthy full-term neonate via Cesarean section at 38 weeks. Superfetation is typically rare from suppression of follicular development and ovulation during pregnancy. Various theories have been proposed to explain its etiology, including polyovulation, delayed blastocyst implantation, and abnormal estrogen and b-hCG surges. In
superfetation, an embryo resulting from a previous conception coexists with another embryo, either intrauterine, resulting in diamniotic dizygotic twins with significantly different gestational ages, or extrauterine resulting in HP. Despite being particularly challenging to diagnose because its presenting symptoms can overlap with those of other more common clinical conditions in early pregnancy, HP is increasingly seen with ARTs. In addition, the treatment of HP is versatile, ranging from expectant management to laparoscopic surgery. High level of suspicion for HP and
superfetation is crucial in patients who, after ART, present with abdominal pain, hemodynamic instability, or anemia. Additionally, patients planning to undergo subsequent ART cycles should be thoroughly screened with b-hCG and TVUS to exclude an ongoing intrauterine or extrauterine pregnancy.