感染性流産を伴った子宮頸管妊娠の一例

抄録

Objective: Cervical pregnancy is a rare condition with an incidence of less than 0.15% of all ectopic pregnancies. The cause of ectopic pregnancy is unknown, however a history of curettage or cesarean section is considered to play a role. We report a case of cervical pregnancy with infected abortion.
Case: A 44-year-old woman, gravida 4 para 2, with a history of 2 spontaneous abortions, presented to a local clinic with irregular vaginal bleeding, lower abdominal pain, and pyrexia. She had undergone a cesarean section at the age of 24 years, and curettage at the age of 40 years. She was admitted to our hospital under the diagnosis of infected abortion. Pelvic magnetic resonance imaging (MRI) indicated cervical pregnancy, ruling out the possibility of cicatricial pregnancy. Despite administration of intravenous antibiotics, she developed sepsis. Total laparoscopic hysterectomy was performed because of uncontrolled infection.
Conclusion(s): Pelvic MRI can efficiently differentiate cervical pregnancy from cicatricial pregnancy, and confirm the status of invasion of chorionic tissue, thus helping in the selection of an appropriate operation method. Total laparoscopic hysterectomy successfully removes the focus of infection in cases of unresponsiveness to intravenous antibiotics, and is the therapy of choice especially in those with no desire for childbearing.