误诊为先兆流产的复合妊娠临床分析  

Clinical Analysis of Heterotopic Pregnancy Misdiagnosed as Threatened Abortion

作　　者：吴朋文 李冰 牛三强 杜宁宁[3] WU Pengwen;LI Bing;NIU Sanqiang;DU Ningning(Graduate School of Bengbu Medical University,Bengbu,Anhui 233000,China;Department of Gynecology and Obstetrics,People's Hospital of Bozhou City Practice Teaching Base of Bengbu Medical University,Bozhou,Anhui 236800,China;Department of Reproductive Medicine,People's Hospital of Bozhou City Practice Teaching Base of Bengbu Medical University,Bozhou,Anhui 236800,China)

机构地区：[1]蚌埠医科大学研究生院,安徽蚌埠233000 [2]蚌埠医科大学实践教学基地亳州市人民医院妇产科,安徽亳州236800 [3]蚌埠医科大学实践教学基地亳州市人民医院生殖医学科,安徽亳州236800

出　　处：《临床误诊误治》2025年第7期25-30,共6页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨复合妊娠的临床特点及鉴别诊断要点,以减少误诊误治。方法回顾性分析2023年10月收治1例被误诊的复合妊娠患者的临床资料,并复习相关文献。结果患者体外受精-胚胎移植术后30余天出现间断下腹隐痛2 d,无明显阴道流血及流液,外院B超检查后初诊为先兆流产,予对症治疗后无缓解。入院后行阴道彩超检查提示宫内外复合妊娠,误诊时间2 d。确诊后行开腹左侧输卵管及妊娠物切除术,术后病理提示左侧输卵管妊娠物,治愈出院,现已顺利分娩。结论复合妊娠的发生较为罕见,因临床表现多样且缺乏特异性,极易导致误诊或漏诊。在临床实践中遇到体外受精-胚胎移植或促排卵助孕患者出现腹痛、阴道流血等症状时,应开拓思路,考虑复合妊娠可能,及时对子宫及附件区域进行详细的超声扫描,并动态评估,以减少或避免复合妊娠的早期误诊。Objective To explore the clinical characteristics and differential diagnosis of heterotopic pregnancy in or⁃der to reduce misdiagnosis and mistreatment.Methods The clinical data of a patient with misdiagnosed heterotopic pregnan⁃cy admitted in October 2023 were retrospectively analyzed,and the relevant literature was reviewed.Results More than 30 d after in vitro fertilization and embryo transfer,the patient presented with intermittent cryptic pain in the lower abdomen for 2 d,without obvious vaginal bleeding and fluid flow.Threatened abortion was initially diagnosed after B⁃ultrasound examina⁃tion in another hospital,and no relief was achieved after symptomatic treatment.After admission to our hospital,vaginal ultra⁃sonography indicated intrauterine and extrauterine heterotopic pregnancy,and the misdiagnosis lasted 2 d.After diagnosis,laparotomy was performed on the left fallopian tube and gestational excision.Postoperative pathology indicated pregnancy in the left fallopian tube,and the patient was cured and discharged.The delivery has now been successful.Conclusion The occur⁃rence of heterotopic pregnancy is relatively rare,and due to various clinical manifestations and lack of specificity,it is prone to misdiagnosis or missed diagnosis.In clinical practice,when patients with in vitro fertilization and embryo transfer or ovula⁃tion⁃assisted pregnancy have symptoms such as abdominal pain and vaginal bleeding,it is necessary to develop new ideas,consider the possibility of heterotopic pregnancy,timely conduct detailed ultrasound scanning of the uterus and the accessory area,and conduct dynamic assessment,in order to reduce or avoid the early misdiagnosis of heterotopic pregnancy.

关 键 词：复合妊娠 误诊 先兆流产 鉴别诊断 异位妊娠 胚胎移植 预后 腹痛 

分 类 号：R714.2[医药卫生—妇产科学]