Clinical Retrospective Analysis Of Special Ectopic Pregnancy

Objective: The purpose of this study is to understand special ectopic pregnancy, including ovaries, cervix, abdomen, cornua uteri, rudimentary horn of uterus, and lower segment scar of uterus, to analysis their disease-related factors, etiology, treatment measures and prognosis.Methods: I collected a total of 1000 patients with ectopic pregnancy, 65 cases with rare ectopic pregnancy treated cases of medical records in department of Obstetrics and Gynecology in Jilin University First Hospital during January 2000 ~ January 2010. With descriptive, retrospective comparative methods of analysis, I applied EXCEL software to build database and used chart and X2 test to statistically analyze clinical data, incidence, related factors, comparison of preoperative misdiagnosis rate, changes in clinical features, treatment and prognosis in the 65 cases of rare ectopic pregnancy during 10 years in our hospital.Results: 1, During 10 years, we treated 1000 cases of ectopic pregnancy in our hospital, of which 935 cases of tubal pregnancy, 65 cases of special ectopic pregnancy, which accounted for 6.50%. Ovarian pregnancy is the highest incidence with 29 cases (44.6%) among rare ectopic pregnancy, uterine horn pregnancy with 21 cases (32.3%), cervical pregnancy with 8 cases (12.3%), abdominal pregnancy with 3 cases (4.6%), tubal remnant pregnancy with 2 cases (3.1%), however, the lowest incidence is uterine scar pregnancy and rudimentary uterine horn pregnancy with 1 case (1.5%). 2, Although color Doppler ultrasound diagnosis technology is progressing, the correct diagnosis of tubal pregnancy rate rising, the misdiagnosis rate only 1.39%, but the rate of misdiagnosis of special ectopic pregnancy is very high, all are misdiagnosed except some cornual pregnancy and cervical pregnancy. Ovarian pregnancy often go to hospital because of abdominal pain or bleeding, even shock, is usually misdiagnosed as tubal pregnancy or pregnant corpus luteum ruptured; cornual pregnancy appears abdominal pain and vaginal bleeding late, some patients may have no symptoms. Most of cervical pregnancy have postmenopausal history and history of irregular vaginal bleeding, easily misdiagnosed as threatened abortion or intrauterine pregnancy; rudimentary uterine horn pregnancy is often treated as acute abdominal disease, misdiagnosed as adnexal mass or tubal pregnancy; due to low location of embryo implantation, uterine scar pregnancy is easily misdiagnosed as inevitable abortion or cervical pregnancy. 3, History of pelvic infection is closely related with ovarian pregnancy and cornual pregnancy. IUD placement is relevance with ovarian pregnancy. 4, Most of rare ectopic pregnancies have manifestations of menopause, abdominal pain and vaginal bleeding; severe cases appear abdominal bleeding and shock symptoms. But because of the different parts of pregnancy, each has its particularity: comparing with cornual pregnancy and cervical pregnancy, ovarian pregnancy has clinical features of intra-abdominal hemorrhage and massive vaginal bleeding. Ovarian pregnancy and other rare ectopic pregnancy are prone to anemia, comparing with uterine horn pregnancy. 5, In 65 patients, the urine pregnancy test was positive in 49 patients, 41 patients with elevated serum human chorionic gonadotropin and 24 cases with uncoagulable blood in puncture of abdominal or posterior fornix. B ultrasound diagnosis correctly in 18 cases, 12 of 13 cases of cornual pregnancy directly prompted; 5 of 8 cases of cervical pregnancy were diagnosis accurately. Ovarian pregnancy has positive correlation with puncture of posterior fornix. B ultrasonic examination has a more obvious meaning for cervical and uterine horn pregnancy, but is no significant results for ovarian pregnancy or other special parts of pregnancy. 6, all of the ovarian pregnancy were treated with surgical treatment, except 1 case was used resection of affected annex, others underwent partial resection or wedge resection of ovary. 5 patients of cornual pregnancy were treated conservatively, others underwent surgery. 4 cases of cervical pregnancy were treated with conservative treatments, others underwent operations. The remaining patients of rare ectopic pregnancy were treated by surgery. Conclusion:1. the incidence of rare ectopic pregnancy followed by ovarian pregnancy, cornual pregnancy, cervical pregnancy, abdominal pregnancy, tubal stump pregnancy, the lowest incidence are uterine scar pregnancy and rudimentary uterine horn pregnancy.2. rate of misdiagnosis in rare ectopic pregnancy is very high. History of pelvic infection is closely related with ovarian pregnancy and cornual pregnancy. IUD placement is relevance with ovarian pregnancy.3. ovarian pregnancy has clinical feature of intraperitoneal bleeding much more serious, cervical pregnancy and uterine scar pregnancy are prone to mass vaginal bleeding, secondary anemia, even shock and death.4. B ultrasonic examination is more meaningful for diagnosis of cervical pregnancy and cornual pregnancy. Ovarian pregnancy has positive correlation with puncture of posterior fornix.5. once specific ectopic pregnancy is diagnosis, or appearing abdominal pain, bleeding or high degree of suspected cases, it should be immediately operated. Conservative treatments of Mifepristone with MTX and curettage can be used for early treatment of cervical pregnancy.