A Retrospective Analysis:Late Pregnancy Outcomes And Risk Factors Of Angular Pregnancy

Background and ObjectiveAngular pregnancy(AP)means that the fertilized egg is implanted in medial side of the uterine tubal junction and the lateral corner of the uterine cavity,surrounded by myometrium.Strictly speaking,angular pregnancy is not ectopic pregnancy,should belong to the category of intrauterine pregnancy.In the past 100 years,angular pregnancy has often been confused with interstitial ectopic pregnancy,and the adverse outcomes of ectopic pregnancy,such as high mortality,have been equated with those of angular pregnancy,so angular pregnancy is often terminated prematurely in clinic,resulting in pregnancy failure.At present,the number of cases reported in the literature is small,the incidence of pregnancy outcomes in the third trimester of pregnancy varies greatly,and the clinical guidance is not clear.In this study,we retrospectively analyzed and compared the medical records of patients with angular pregnancy diagnosed during cesarean section in our hospital and those with normal cesarean section,and explored the related risk factors during pregnancy of patients with angular pregnancy,as well as the clinical outcomes of the third trimester,and intraoperative management,to provide reference for clinical management of angular pregnancy.MethodsThe clinical data of patients who were hospitalized in the obstetrics department of the second affiliated Hospital of Zhengzhou University and terminated their pregnancy by cesarean section from September 2018 to December 2020 were collected.At the same time,general gravidas who delivered by cesarean section in the Second Affiliated Hospital of Zhengzhou University from December 2019 to December 2020 were selected.The patients who were diagnosed as angular pregnancy during operation were taken as research group(n=63),general gravidas with normal cesarean section were taken as the control group(n=205).Both groups of patients were performed cesarean section by the same surgeon.The general clinical data,intraoperative and postoperative conditions and the birth of newborns between the two groups were analyzed and compared,and statistical analysis was carried out.Results1.Logistic regression analysis showed that the independent risk factors for angular pregnancy included history of artificial abortion,history of pelvic operation,early vaginal bleeding and early ultrasound abnormalities(Ultrasound shows that the gestational sac is close to one side).2.There was no significant difference in the amount of intraoperative bleeding,placental implantation rate,term delivery rate,premature delivery rate,neonatal Apgar score,utilization rate of special hemostatic methods,postoperative hospital stay and subinvolution of uterus between the two groups(P > 0.05).The operation time,manual placental separation rate and the utilization rate of powerful uterine contraction drugs in research group was significantly higher than those in the control group(P < 0.05).3.The levels of HGB and HCT after operation in both groups were lower than those before operation,but there was no difference between the two groups(P >0.05).4.There were no intraoperative blood transfusion,uterine rupture,hysterectomy or maternal and infant death in both groups.Conclusions1.Patients with a history of induced abortion,pelvic surgery,vaginal bleeding in the first trimester,or the gestational sac close to one side of the uterine angle by ultrasound have a greater risk of angular pregnancy.Close dynamic color Doppler ultrasound monitoring should be performed for such pregnant women,and education and supervision during pregnancy should be strengthened.2.The pregnancy outcomes of late pregnancy of angular pregnancy is similar to that of general gravidas.There is no need for special treatment during cesarean section,but attention should be paid to the timing of manual placental removal,and powerful uterine contractile agents should be used preventively if necessary.3.The early asymptomatic angular pregnancy has the potential to be expected to the third trimester,so it is necessary to decide carefully whether to terminate it or not.