Analysis Of The Clinical Outcome Of Early Pregnancy Ultrasound Diagnosis Of Cornual Pregnancy After Treatment

Objective:To explore the clinical outcome of early ultrasound diagnosis of cornual pregnancy after treatment.To analyze the general clinical data,ultrasonic examination,laboratory examination results and the clinical outcome of different surgical methods in the early diagnosis of cornual pregnancy,in order to improve the diagnostic accuracy of cornual pregnancy and provide evidence for the rational treatment of cornual pregnancy.Methods:A retrospective analysis was carried out on 107 cases of cornual pregnancy diagnosed and treated in Dalian maternal and child health hospital from January 2014 to January 2019.Among them,59 cases were definitely diagnosed by operation and pathological examination and included in this study.Among them,31cases were definitely diagnosed as cornual pregnancy,28 cases as interstitial pregnancy.To compare the general clinical characteristics,laboratory results and ultrasound results of early cornual pregnancy and early tubal interstitial pregnancy.Clinical features include:age,BMI,menopause time,symptoms?no/abdominal pain or vaginal bleeding?,pregnancy times,previous delivery times,induced abortion times,previous delivery history,induced abortion history,previous tubal pregnancy history,cesarean section history,pelvic surgery history,whether it is a pregnancy by promoting expulsion.Laboratory tests include:human chorionic gonadotropin?HCG?,estradiol?E₂?and progesterone?P?.Ultrasound examination includes:endometrial thickness,gestational sac size,gestational site,whether there is embryo or heart beat,blood flow signal around gestational sac,whether gestational sac is connected with endometrium,whether the mass is convex,and the thickness of myometrium around gestational sac.The factors influencing the choice of surgical treatment of cornual pregnancy include:age,menopause time,preoperative and postoperative?-h CG level and degree of decline,symptoms?no/abdominal pain or vaginal bleeding?,gestational sac size,thickness of myometrium around the gestational sac,blood flow signals around the gestational sac,external bulge of the mass,use of embryo killing drugs before and after the operation,hemoglobin and changes before and after the operation,and estimation blood loss,blood transfusion,operation time and postoperative hospital stay were calculated.All the data in the study were analyzed by IBM SPSS Statistics 22.0.Results:The age of cornual pregnancy was significantly lower than that of tubal interstitial pregnancy.The preoperative diagnosis of cornual pregnancy is mainly based on transvaginal ultrasound and related laboratory tests.The results showed that the level of serum?-h CG in the group of cornual pregnancy was significantly higher than that in the group of tubal interstitial pregnancy,while the level of serum progesterone and estradiol had no significant difference.But the level of serum progesterone in the group of cornual pregnancy was higher than that in the group of tubal interstitial pregnancy.Transvaginal ultrasound is still the first choice in clinical diagnosis of early cornual pregnancy.We found that the accuracy of ultrasound diagnosis of cornual pregnancy is52.54%.There are obvious differences between cornual pregnancy and interstitial pregnancy:when cornual pregnancy,the gestational sac is connected with endometrium,surrounded by myometrium,bilateral cornual asymmetry,one cornual dilation without external convex or slight external convex.During tubal interstitial pregnancy,there is no connection between the gestational sac and the endometrium.There is myometrium between the two,i.e."interstitial line sign".There is no obvious myometrium wrapping around the two sides of the uterine angle.The two sides of the uterine angle are still symmetrical,and there are obvious convex masses near the uterine angle.Among 59 cases diagnosed by operation and postoperative pathology,31 cases?52.54%?were cornual pregnancy and 28 cases?47.46%?were interstitial pregnancy.The operation was successful in all patients.Among 31 cases of cornual pregnancy,1case underwent laparotomy because of rupture of pregnancy mass,intraperitoneal hemorrhage and hemodynamic instability.16 cases were treated by hysteroscopy alone.One of them was not completely resected because of the thin distance between the focus of pregnancy and serosa during the operation.The family refused laparoscopic operation and received MTX chemotherapy after the operation.14 patients were treated by hysteroscopy and laparoscopy.One of them was sutured with"8"shape at the corner of the uterus by laparoscopy because of the excessive bleeding of vagina during the operation,and the bleeding point was detected by hysteroscopy,but the hemostasis could not be reached.Through retrospective analysis of the clinical data of hysteroscopy alone group and hysteroscopy and laparoscopy combined operation group,we found that there were significant differences between the two groups in operation time and postoperative hospital stay.The operation time and postoperative hospital stay in the simple hysteroscopic operation group were significantly shorter than those in the combined hysteroscopic and laparoscopic operation group.Conclusion:1?Cornual pregnancy is still a challenging and potentially dangerous clinical disease.The choice of treatment depends on various parameters.In clinical management of cornual pregnancy,experience plays a great role.2?It is necessary to monitor the change of h CG before operation and improve the level of serum progesterone,which is helpful for the diagnosis of cornual pregnancy.3?Ultrasonography showed that nearly half of the patients with early cornual pregnancy were tubal interstitial pregnancy.4?Ultrasonography is still the main auxiliary examination for the diagnosis of early cornual pregnancy,in which the connection between the gestational sac and the endometrium,the thickness of the myometrium around the gestational sac and the external bulge of the masses are helpful for the differential diagnosis of tubal interstitial pregnancy.5?The effect of hysteroscopic surgery on cornual pregnancy is positive,but the combination of hysteroscopy and laparoscopy is more recommended,especially for cornual pregnancy with high HCG value,large mass,thin muscular layer around the gestational sac and rich blood flow signals.