子宮頸管・卵管同時妊娠の１例～診断と治療戦略策定の思考過程～

抄録

Introduction: Multiple ectopic gestations are extremely rare. Multiple ectopic pregnancies occur less frequently than heterotopic gestations and may appear in a variety of locations and combinations. However, with the advent of assisted reproductive technologies (ART), the incidence appears to be rising. We encountered a case of simultaneous pregnancies in the cervix and the left fallopian tube after ART.

Case: Though the serum human chorionic gonadotropin (hCG) value of a 39-year-old female with two transferred embryos was 9,687 mIU/mL at 5 2/7 weeks of pregnancy, ultrasonography showed no gestational sac in her uterus. Three days later, when the serum hCG level reached 13,499 mIU/mL, ultrasonography revealed cysts in both the cervix and the left adnexa. Magnetic resonance imaging (MRI) showed simultaneous pregnancies in the cervix and the left fallopian tube. First, laparoscopic salpingectomy was performed for the left tubal pregnancy. The next day, the gestational sac in the cervix was expelled spontaneously with little blood loss. Villi were found pathologically in both the excised left fallopian tube and the tissue excreted from the cervix.

Conclusion: For multiple ectopic pregnancies at different sites that are difficult to treat at the same time, we propose promptly carrying out the treatment that can be reliably completed with a small physical burden on the patient. This facilitates the planning of the therapeutic strategy for the remaining ectopic pregnancy.