Cornual pregnancy

　　Cornual pregnancy refers to the implantation and growth and development of the fertilized egg in the uterine horn, which often occurs in primiparas. It is characterized by the presence of a smaller uterus in addition to the normal uterus, and sometimes the endometrial line can be seen in the uterine cavity. The uterine horn is a congenital developmental anomaly, which is the outcome of an abnormality in the process of Mullerian duct fusion during embryogenesis, leading to incomplete development of one side of the Mullerian duct. The main causes of cervical pregnancy include the following:

　　10. Inflammation

　　Cervicitis causes the loss of motility of the cilia on the surface of the cervical endometrial cells and leads to local narrowing of the cervix and other pathological changes, which causes the fertilized egg to be blocked at the narrow site, leading to cornual pregnancy.

　　8. Intrauterine device

　　Whether intrauterine devices increase the incidence of cornual pregnancy cannot be easily concluded at present. It may be related to the type of intrauterine device, the population, and the observation method. However, clinical evidence shows that intrauterine devices can indeed cause cornual pregnancy.

　　6. Influence of sex hormones

　　Under normal circumstances, the appropriate ratio of estrogen and progesterone can work synergistically to allow the fertilized egg to be transported into the uterine cavity by the normal ciliary movement of the uterine tube epithelium and the muscular peristalsis. If the balance of estrogen and progesterone is disrupted, it can lead to cornual pregnancy.

　　4. In vitro fertilization and embryo transfer

　　It may be accidental to inject the embryo into the cervix or for the embryo to migrate from the uterine cavity to the cervix when the cervix already has certain lesions, which cannot allow the embryo to return to the uterine cavity. In addition, the transport of gametes through the cervix also easily leads to cornual pregnancy. Therefore, the incidence of cornual pregnancy is higher than that of natural pregnancy.

　　5. Other

　　Pregnancy in the cornual part of the uterus (such as cervical erosion and other conditions) or congenital developmental anomalies of the cervix (such as elongation, diverticula, etc.), early or delayed ovulation can all lead to cornual pregnancy. If there is no miscarriage in the early pregnancy, these symptoms will disappear by the middle of pregnancy. In fact, there is no absolute boundary between cornual pregnancy and normal pregnancy in terms of anatomy. Therefore, the incidence of cornual pregnancy will depend on the extremely mild symptoms at the early stage of pregnancy, and further examination is required to detect it. Patients with cornual pregnancy (ectopic pregnancy) often report severe abdominal pain around the 12th week of pregnancy, which may be accompanied by or without vaginal bleeding, and the uterus shows asymmetrical enlargement.

　　Cornual pregnancy can cause various complications, the most common being abortion, uterine rupture, and placental retention. Uterine rupture is the most serious complication. Cornual pregnancy is prone to placental retention, difficult to剥离, and cannot be stopped by curettage. The only method is to resect the cornual part of the uterus. Cornual pregnancy is distinguished from interstitial pregnancy of the fallopian tube. The interstitial part of the fallopian tube is located at the cornu, the junction where the fallopian tube leads to the uterus, surrounded by uterine muscle tissue, about 2.0 cm in length. The fertilized egg implants in this part to form interstitial pregnancy. Since the gestational egg implants and develops outside the uterine cavity at the cornual opening of the fallopian tube, it belongs to the category of ectopic pregnancy. During laparoscopic examination or laparotomy, the distinction between cornual pregnancy and interstitial pregnancy of the fallopian tube can be made based on the relationship between the round ligament and the protruding mass. If the round ligament is located on the outer side of the protruding mass, it is cornual pregnancy; if it is located on the inner side, it is interstitial pregnancy of the fallopian tube.

　　The treatment for cornual pregnancy, if it belongs to the流产 type, can be performed evacuation or B-ultrasound and laparoscopic examination, and HCG quantitative follow-up examination is necessary if necessary. Once it ruptures, it is one of the acute abdominal emergencies that are severely life-threatening to women, so immediate surgery must be performed, and blood volume should be supplemented as soon as possible to ensure blood supply to vital organs. For those whose blood pressure cannot rise immediately, surgery should be performed while anti-shock treatment is being given to save time. The cornual part is the junction where the fallopian tube leads to the uterus, surrounded by uterine muscle tissue, where the uterine and ovarian arteries meet and converge. The blood vessels are rich, and the fertilized egg implants here to form cornual pregnancy, which is rare in ectopic pregnancy. The clinical manifestations often include a history of amenorrhea and early pregnancy reactions. Compared with other ectopic pregnancies, due to the muscle tissue around the cornu, the rupture time is later, even reaching 16-18 weeks of pregnancy. Once it ruptures, the condition is serious, and if not treated in time, it can lead to death. It is difficult to distinguish cornual pregnancy from intrauterine pregnancy before 8 weeks of pregnancy. The examination of the uterus shows an increase that corresponds to the days of amenorrhea, but the cornual part is significantly softer. B-ultrasound examination can clearly identify cornual pregnancy, showing an enlarged uterus with one corner protruding, where the gestational ring or embryo can be seen, and there is no pregnancy material in the uterine cavity. Only by carefully excluding cornual pregnancy before abortion treatment can we avoid artificially induced rupture of ectopic pregnancy, and even tragic deaths.

　　A small number of patients have no obvious symptoms in the early stage of pregnancy and ultrasound examination cannot find the gestational sac. Vaginal four-dimensional color Doppler ultrasound and blood HCG can be used for screening, and hysteroscopic laparoscopy can be performed if necessary. This type of ectopic pregnancy is not easily discovered in the early stage because there is no bleeding, and it is also easily misdiagnosed by ultrasound. It usually ruptures after 3 months of amenorrhea, and once it ruptures, it will cause a large amount of internal bleeding, shock, and death. Many cases show that the pregnant uterus increases asymmetrically, and it often gives birth smoothly in the late stage of pregnancy.

　　After the fetus is delivered, the placenta often remains in one corner of the uterus and needs to be manually stripped. The closer the site of implantation of the fertilized egg is to the internal orifice of the fallopian tube, the more obvious the asymmetric shape of the uterus, and the symptoms such as abdominal pain are also more obvious. The symptoms of ectopic pregnancy in women of childbearing age include missed periods, sometimes accompanied by early pregnancy reactions such as anorexia and nausea, indicating pregnancy but suddenly experiencing lower abdominal pain, which may be continuous or recurrent, accompanied by discomfort such as nausea, vomiting, and anal descent. In severe cases, the patient may have pale complexion, cold sweat, cold limbs, and even fainting or shock. Some patients may have irregular vaginal bleeding, usually less than the amount of menstruation (note: do not mistake this for menstruation). Therefore, the typical symptoms of ectopic pregnancy can be summarized into three major symptoms: amenorrhea, abdominal pain, and vaginal bleeding.

　　A small number of patients with angular pregnancy may not have obvious symptoms in the early stages of pregnancy, and the gestational sac cannot be found by ultrasound. Vaginal four-dimensional color Doppler ultrasound and blood HCG can be used for screening, and hysteroscopic exploration may be necessary if necessary. This severely affects the patient's daily life, so it should be actively prevented. The main method of prevention for angular pregnancy is to treat inflammation and infection in a timely manner.

　　The diagnostic criteria for angular pregnancy are not unified at present. The diagnostic criteria proposed by Jansen et al. are: abdominal pain accompanied by asymmetric enlargement of the uterus, followed by abortion or rupture; the uterine horn on one side is found to be dilated under direct vision, with the round ligament laterally displaced; the placenta is retained in the uterine horn. Those who meet one of the above criteria can be considered as angular pregnancy. The diagnostic criteria for ultrasound imaging are: the gestational sac is located in the uterine horn, is continuous with the endometrial line, and has a complete muscular wall layer around it. Vascular interventional treatment is applied to a few cases of angular pregnancy, and its treatment method is similar to that of cervical pregnancy.

　　First, indications:

　　1. Angular pregnancy has not ruptured, and the vital signs are stable.

　　2. Ultrasound examination shows that the diameter of the gestational sac is ≤5cm.

　　3. Blood B-HCG
　　Second, contraindications:

　　1. Angular pregnancy has ruptured, with a large amount of intra-abdominal bleeding and extremely unstable vital signs.

　　2. Patients with severe dysfunction of important organs such as the heart, lungs, liver, and kidneys.

　　3. Patients with severe abnormalities in blood coagulation mechanism. The principle is to administer medication through arterial infusion to the main blood supply vessels of the target organ, so that the drug distribution in the target organ is not affected by blood flow distribution, allowing for maximum local drug distribution, which can achieve the effect of improving efficacy. At the same time, embolizing the uterine artery can prevent massive bleeding.

　　Three, the key 3 steps for the examination and treatment of angular pregnancy (ectopic pregnancy):

　　1. Early vaginal four-dimensional color Doppler ultrasound to determine the location of the gestational sac.

　　2. Once discovered, an immediate combined cesarean section and laparoscopic surgery should be performed under the supervision of a laparoscope close to the uterine cavity for embryo extraction, and a laparoscopic window should be opened for embryo extraction at a distance from the uterine cavity, followed by suture and tube placement.

　　Once it ruptures, an urgent laparoscopic surgery should be performed to repair the rupture and return the blood to the body.

　　The daily diet taboos for angular pregnancy include the following five points:

　　1. Protein and inorganic salts are particularly important.Sufficient protein can promote the development of the fetus's brain and improve the intelligence level of the fetus. In addition, calcium and phosphorus are essential elements for the development of fetal bones and teeth, while iron is an important element for the production of blood and tissue cells. Therefore, pregnant women should eat more eggs rich in calcium, shrimp shells, beans, and lean meats rich in iron.

　　2. Zinc Deficiency in Early PregnancyDeficiency of zinc in the early stage of pregnancy can lead to congenital malformations. Therefore, pregnant women must pay attention to obtaining zinc from dietary sources. Animal foods such as meat and fish are the main sources of zinc, and plant foods such as buckwheat, rye, wheat, corn, peanut kernels, and walnut kernels also contain a high amount of zinc.

　　3. Supplement vitamins in moderation.Vitamin A can enhance the resistance of pregnant women and help the growth and development of the fetus; Vitamin B can promote appetite, stimulate milk secretion, and promote fetal growth; Vitamin C can promote the development of fetal bones and teeth and enhance resistance. These vitamins can be supplemented appropriately. Vitamin D can help the absorption of calcium and phosphorus, and ensure the normal development of bones and teeth. In areas with sunshine, vitamin D supplementation may not be necessary.

　　4. Pay attention to the intake of folic acid.Folic acid mainly exists in various green leafy vegetables. A small amount of folic acid in the body is a water-soluble vitamin, which can be dissolved in water. Pregnant women must eat a certain amount of fresh vegetables to obtain enough folic acid. Surveys have shown that most pregnant women with a history of miscarriage or signs of miscarriage during pregnancy have insufficient folic acid intake. When eating various stir-fried vegetables, the soup should be eaten. Pregnant women can also supplement folic acid by eating some raw vegetables such as rapeseed and pak choi. In addition, green vegetables contain many kinds of nutrients needed by humans, and pregnant women should eat more green vegetables. Water and roughage are essential during pregnancy. Pregnant women should also pay attention to the intake of water and roughage. They should drink water in moderation and eat more fresh vegetables and fruits rich in fiber to promote peristalsis and prevent constipation.

　　5. Taboos:Pregnant women should not eat animal livers.

　　The Western medicine treatment of cornual pregnancy is mainly abdominal surgery. With the improvement of ultrasonic technology, the extensive application of laparoscopic technology and drug treatment, especially the application of angiography examination technology, conditions have been created for conservative treatment of cornual pregnancy.