گزارش يك مورد درمان محافظه‌كارانه موفقيت‌آميز در حاملگي سرويكال: گزارش موردي

Successful conservative management of cervical pregnancy: case report

مينه و هدف: بارداري سرويكال نوعي نادر از بارداري‌هاي خارج رحم است. نوع درمان وابسته به وضعيت هموديناميك بيمار مي‌باشد كه مي‌توان از درمان محافظتي تا درمان تهاجمي مانند هيستركتومي اورژانس را به‌كار برد. هدف از اين گزارش معرفي يك مورد درمان محافظه‌كارانه موفقيت‌آميز حاملگي سرويكال بود. معرفي‌بيمار: زن 30 ساله حاملگي دوم و سابقه تولد زنده و يك‌بار سزارين پيشين كه با تشخيص اوليه سقط فراموش شده در سال 1396 به بيمارستان قائم (عج) مراجعه كرد. به‌دليل عدم دفع در حين كورتاژ، بارداري سرويكال تشخيص داده شد. خونريزي واژينال شديد تهديدكننده حيات با سوند فولي داخل رحمي حاوي cc 60 نرمال سالين و گذاشتن تامپون داخل واژن كنترل و بيمار با حال عمومي خوب مرخص شد. نتيجه‌گيري: در بيماران با بارداري سرويكال و وضعيت هموديناميك نامناسب و تمايل به حفظ باروري، جاگذاري سوند فولي داخل رحم همراه با گذاشتن تامپون داخل واژن به‌دنبال كورتاژ، كمك‌كننده مي‌باشد.

Background: Cervical pregnancy is a rare type of ectopic pregnancy (EP) in which the pregnancy implants in the lining of the endocervical canal. It accounts for less than 1 percent of ectopic pregnancies. The cause is unknown; local pathology related to previous cervical or uterine surgery may play a role given an apparent association with a prior history of curettage or cesarean delivery. The most common symptom of cervical pregnancy is vaginal bleeding, which is often profuse and painless. Lower abdominal pain or cramps occur in less than one-third of patients; pain without bleeding is rare. It is important to think about the possibility of cervical pregnancy in such patients since early diagnosis is critical to avoidance of complications and successful treatment. Management of this pregnancy is dependent on the hemodynamic status of the patient. Conservative management and some more aggressive therapy such as emergency hysterectomy can be used. The aim of this report was to introduce a case of successful conservative management of cervical pregnancy. Case presentation: A 30-year-old G2L1 woman with history of a previous cesarean section and possible diagnosis of missed abortion referred to the Gynecology Clinic of Ghaem Hospital, Mashhad University of Medical Sciences, Iran, in 21 May 2017. Cervical pregnancy was diagnosed during curettage. Severe hemorrhage occurred after curettage and the hemodynamic status of the patient was unstable immediately after curettage. Severe threatening vaginal bleeding was controlled with intrauterine Foley catheter containing 60 cc normal saline and then vaginal packing. The patient was discharged with good general condition. Conclusion: In cervical pregnancy and unstable hemodynamic status and desire to preserve fertility, intrauterine Foley catheter and vaginal packing after curettage is helpful.