Inventory of ectopic pregnancy in odd sites Author: MedSci Source: MedSci Published: 2015-8-24 Share to: 1 Tags: ectopic pregnancy Ectopic pregnancy Rare A few days ago, the Department of Obstetrics and Gynecology of Renji Hospital South Hospital, Shanghai Jiaotong University, successfully treated a patient with a rare splenic pregnancy. The patient, a 25-year-old female with a history of two cesarean deliveries, was referred to the Department of Obstetrics and Gynecology of Renji Hospital South Hospital because she had “menopause for 2 months and irregular vaginal bleeding for 14 days” and was unable to confirm the diagnosis. The patient’s blood HCG was progressively elevated after admission, and after meticulous examination, a 6 cm-sized suspicious pregnancy-like mass next to the splenic portal was finally detected during abdominal CT. The ultrasound director performed another ultrasound examination and found a pregnancy mass at the splenic hilum with a viable fetus nearly 3 months in size. During surgery, laparoscopic exploration revealed that the gestational sac was large and closely connected to the splenic vein, and considering the complexity of the operation, it was finally decided to perform open abdominal gestational mass excision and splenectomy. During the operation, the fetus was found to be located at the splenic hilum and was already formed. The operation was completed successfully until the early hours of the next day with minimal intraoperative bleeding. The postoperative recovery was good. Splenic pregnancy is extremely rare in clinical practice and often results in maternal death due to misdiagnosis. The timely diagnosis of this rare case fully demonstrates the excellent clinical strength of Renji Hospital and its OB/GYN team. The concept of ectopic pregnancy is not unfamiliar, which is known as ectopic pregnancy. It is often caused by tubal inflammation and its peripheral inflammation, abnormal function of the fallopian tubes, etc., resulting in damage to the cilia of the fallopian tubes and abnormal movement, which affects the fertilized egg’s implantation. The most common site of ectopic pregnancy is tubal pregnancy (potbelly), followed by ovarian pregnancy, abdominal pregnancy, broad ligament pregnancy, and cervical pregnancy. Ovarian pregnancy: the incidence is 1:7000-1:50000. The diagnostic criteria are: 1. normal bilateral fallopian tubes; 2. the follicle is located in the ovarian tissue; 3. the ovary and the follicle are attached to the uterus by the ligament inherent to the ovary; and 4. there is ovarian tissue on the wall of the follicle. Clinical features are no obvious history of menopause and significant abdominal pain. Pathologic features are the presence of embryos or villi in the ovarian tissue and normal ipsilateral fallopian tubes. The etiology of ovarian pregnancy may be closely related to poor uterine environment, pelvic inflammatory disease and endometriosis, and treatment is surgical. Abdominal pregnancy: refers to pregnancy located in the fallopian tube, ovary and broad ligament unexpectedly in the abdominal cavity, with an incidence of 1:15,000, maternal mortality rate of 5% and fetal survival rate of only 1%. 1, liver pregnancy: it is known that in the world, there are about ten cases of liver pregnancy recorded, and the earlier domestic record is a case of liver pregnancy admitted to Pudong Gongli Hospital in 2004. The patient was admitted with acute abdominal pain and ultrasound showed a fist-sized mass on the surface of the liver. The fetus was seen to be formed intraoperatively and the sex could be distinguished. 2. Mesenteric ectopic pregnancy: In 2011, a hospital in Henan successfully treated a patient with mesenteric pregnancy and hemorrhagic shock. The patient was admitted to the hospital 10 days after abortion with sudden onset of severe pain in the lower abdomen and dizziness. On admission, her vital signs were unstable and signs of shock were obvious. After an emergency dissection, he saw a dark red mesenteric blood collection and a huge retroperitoneal hematoma with bleeding exceeding 3000 ml. The chief physician pointed out that this patient’s ectopic pregnancy was located in the right upper abdomen at the root of the mesentery, and the villi penetrated the mesentery and then were planted next to the abdominal aorta, and the lesion was small and extremely insidious, so it would have been difficult to be detected if not for the hemorrhage due to erosion of blood vessels. It is an extremely difficult and rare case, difficult to confirm the diagnosis before surgery and difficult to operate, so it is not easy to save it. Broad ligament pregnancy: the pregnancy grows and develops between the two lobes of the broad ligament, i.e., retroperitoneal development. It is very rare. In broad ligament pregnancies, the placenta is often poorly developed, resulting in fetal growth retardation, but there are cases of normal fetal development. At full term, patients often experience pseudopregnancy, resulting in fetal death. Pre-operative diagnosis is difficult and abdominal radiographs can be helpful. The principle of treatment is to remove the fetus by cesarean section. The placenta can be treated according to the same principles as in abdominal pregnancy, leaving it in place for later reoperation. If the fetus has been dead for some time and the vascular bed has been blocked, the placenta can be removed at the same time as the surgery. Cervical pregnancy: refers to a fertilized egg that has lodged and developed in the cervical canal; it is extremely rare, with an incidence of 1:18,000. diagnostic criteria: 1. gynecological examination reveals a normal-sized uterus above an enlarged cervix; 2. the pregnancy is completely within the cervical canal; 3. segmental scraping does not reveal any pregnancy products in the uterine cavity. According to news reports, in July 2011, Wuhan Union Hospital rescued a woman with a 7-month cervical pregnancy and removed a 1.4 kg baby girl by caesarean section. The magnetic resonance showed placental adhesions and possible implantation, and bleeding was about 3500 ml at the time of surgery. Cervical pregnancy is easily misdiagnosed as inevitable miscarriage. The diagnosis of ectopic pregnancy in specific areas is often difficult, and it is easy to miss and misdiagnose. The onset of ectopic pregnancy is more dangerous, and resuscitation is not only timely, but also requires the cooperation of physicians from different disciplines. In order to reduce the risk of life and to treat it as early as possible, women of childbearing age should pay attention to abdominal pain and bleeding after menopause, and if pregnancy is confirmed, they should be examined regularly to determine intrauterine and ectopic pregnancy. Follow the doctor’s instructions for regular review and regular postoperative follow-up.