Clinical Analysis Of55Cases With Cornual Pregnancy

Background Cornual pregnancy is the implantation of a fertilized egg in the uterus corner located between the interstitial tubal and uterine cavity, and growth and development toward the uterine cavity side. Cornual pregnancy belongs to the scope of the special type of ectopic pregnancy, which is relatively rare in clinical. Due to cornual decidua poorly developed, trophoblast cells can invade the uterine wall in the first trimester, leading to the myometrial where the pregnancy implantedw weak, combined with the absence of typical clinical manifestations of this disease, therefore, it is very prone to misdiagnosis and mistreatment, severe cases can lead to uterine rupture and profuse hemorrhage, even life-threatening, so early diagnosis and proper treatment is extremely important. Over the last decade, with the rising incidence of ectopic pregnancy, the incidence of cornual pregnancy is also on the rise. It is reported the cornual pregnancy accounted for ectopic pregnancy rate rose from1.7%in the1990s to3.4%in the2000s in16years. At present, the domestic and foreign literature are mainly case reports. Lack of a more comprehensive understanding of the disease etiology, clinical features, diagnosis, and treatment methods, and so far, there isn’t reliable clinical guidance in the diagnosis and treatment, so the disease misdiagnosis rate is always high. Now, to retrospectively analyz the clinical data of55cases cornual pregnancy treated in our hospital Obstetrics and Gynecology department, so as to provide guidance for the clinical diagnosis and treatment of the disease.Objective To investigate the clinical features, diagnosis, treatment, and effect evaluation of cornual pregnancy.Method To analyze retrospectively and summarize the clinical data of55cases cornual pregnancy in Qilu Hospital of Shandong University from January2007to March2013.To explore, analyze and evaluate the related risk factors, clinical manifestations, diagnosis and misdiagnosis, treatment and effects of cornual pregnancy. In accordance with the treatment, the patients with cornual pregnancy were divided into a medical treatment group (40cases), a drug combination ultrasound-guided curettage group (13cases, including8cases diverted to ultrasound-guided curettage after drug treatment failure);In addition, the remaining10cases, respectively, for abdominal debridement surgery (4cases), laparoscopic debridement surgery(2cases), expectant treatment after spontaneous abortion(3cases), and1case required to continue the pregnancy after miscarriage treatment. To compare and evaluate the treatment effects between the two groups from these aspects:treatment success rate, hospitalization time and costs and so on. To seek for better treatment methods and improve the clinical understanding of cornual pregnancy, to enhance the effect of early correct diagnosis and treatment, and to guide clinical work. Results①Risk factors:Among the55cases cornual pregnancy cases, there were42cases with risk factors, accounting for76.36%.②The treatment success rate:In the55patients, drug treatment group (40cases), the success rate was80.00%;drug combined with ultrasound-guided curettage group (13cases), the success rate was76.92%, the difference between the two groups was not statistically significant (P>0.05).③The misdiagnosis rate:In the55patients,25cases were the first misdiagnosed, accounting for45.45%. However, in our hospital there were10cases (18.18%)which first diagnosis is not clear diagnosis, and mostly misdiagnosed as intrauterine pregnancy, gestational trophoblastic disease or tubal ectopic pregnancy and so on. Ultimately uterine horn pregnancy were diagnosed by surgery and pathology. And45cases were first diagnosed cornual pregnancy in our hospital, accounting for81.82%, of which13cases were misdiagnosed outside our hospital.④The hospital stays and hospitalization expenses:the hospital stays of drug treatment group and drug combined with ultrasound-guided curettage group was8.35±4.69days,15±7.86days, the difference between the two groups was statistically significant (P<0.05);the hospitalization expenses of the two groups was3228.73±2341.23yuan,9706.12±4515.59yuan; difference between the two groups was statistically significant (P<0.05).Conclusion①The success rate of medical treatment of cornual pregnancy is high, this mode of cornual pregnancy treatment is simple and easy to do, patients underwent this management needn’t stay in hospital for a long time, and with less trauma, quicker recovery, spent less than other management, so it’s particularly suitable for patients with early, and worthy of promotion in clinic.②The cornual pregnancy’s misdiagnosis rate is high, and its differential diagnosis is difficulty, so the accuracy of early diagnosis needs to further improve.