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子 宮 頸 姙 娠

CERVICAL PREGNANCY

대한의학협회지 1969년 12권 4호 p.441 ~ 450
이동훈,
소속 상세정보
이동훈 (  ) - 부산대학교 의과대학 산부인과학교실

Abstract


Cervical pregnancy can be defined as an ectopic pregnancy in which the implantation and development of the fertilized ovum take place within the structure of the cervix, the uterine body remaining uninvolved.
The present study reports the gross and microscopic evaluation of the specimens of three women undergone abdominal total hysterectomies and whose diagnoses were cervical pregnancy.
The Korean literature contains records of 13 cases of cervical pregnancy including the cases reported here and the total cases are analysed.
Case Reports
Case 1. Mrs. Z. Y. S., age 26, married Mongolian woman, gravida i, with an interruption of two months´ pregnancy, was examined on March 2,1967 because of continuing moderate genital bleeding without pain. Her last menstrual period had begun on December 20, 1966 and spotting had occured at the end of January and in February. Pelvic examination revealed the cervix was firm and enlarged, and the external os was closed. The uterus was somewhat softened and only slightly enlarged. No adnexal masses were palpated. Under the impression of inevitable abortion, diagnostic dilatation and curettage were tried. On dilatating the cervix, massive bleeding was encountered, therefore no further manipulation was done and the vagina was tightly packed with plain gauze.
On March 10, under the general anesthesia and blood transfusion dilatation and curettage were tried again. The internal cervical os constricted and the endometrial cavity was empty and curetted. The cervical canal was cystic enlarged with irregular surfaced lesions, from which the heavy bleeding came, therefore deep sutures were placed bilaterally at the cervix and the vagina was tightly packed.
Some fragments of dark hemorrhagic tissue were curetted from the cervical canal. Pathological examination of the tissue showed secretory endometrium and products of pregnancy at the cervical wall (Placenta cervicalis accreta).
In April and May antibiotic and Varidase tablets were given. Meantime she had occasionally dark spotting. At the end of May, the patient visited a surgeon and underwent again dilatation and curettage Because of the following uncontrolable hemorabdominal total hysterectomy was done by the surgeon. The author was told the gross findings of the operative specimen were completely consistent with cervical pregnancy. The specimen was lost and not submitted to the author.
Case 2. Mrs. J. Z. Z., age 26, married Mongolian woman, gravida i, with an artificial interruption of three months´ pregnancy was transfered and admitted
to Il Sin Womens´ Hospital on July 22, 1967, complaining of painless genital bleeding, Her last menstrual period had begun on March 15, 1967 and two months later she had dark red spotting. Therefore, a physician tried diagnostic dilatation and curettage, ibut because of massive bleeding it failed.
Pelvic examination revealed the uterus was enlarged to the size of three months´ pregnancy, soft, and non-tender on palpation. The cervix was markedly enlarged, spherical and non-tender. The cervical os was slightly opened and dark spotting
was noted. Under the impression of missed abortion or hydatid mole, dilatation and evacuation were tried and confronted with massive hemorrhage from the cervical canal. Therefore, under the general anesthesia abdominal total hysterectomy and right salpingo-cophorectomy were performed.
Pathological examination: Gross findings; The specimen consisted of a totally removed uterus with right tube and ovary, weighing 160 Gm. The cervix was markedly enlarged comparing the uterine body. On opening the uterus, at the posterior aspect of the cervical canal, an irregular shaped, dark reddish elevated lesion, approximately 5.5×5.5×4cm. was seen. The posterior cervical wall was markedly thinned, approximately 0.1-0.2cm. in thickness(Fig. 1, 2, 3).
Microscopic findings; Section showed necrotic chorionic villit, blood dots, decidual ells and trophoblastic cells, which were firmly contacted and attached to the fibromuscular wall of the cervix. At this section cervical glands were seen and masses of trocells were noted at the lymphatic spaces (Fig. 4).
Pathological diagnoses; Placenta cervicalis increta destruens, secretory endometrium, and corpus luteum of right ovary.
Case 3. C. S. Y., age 40, married Mongolian woman, gravida v, para iii, abortion ii, was admitted to Il Sin Womens´ Hospital on April 8, 1968 because of massive genital bleeding. Her last menstrual period had begun on February 12, 1968 and dilatation and evacuation were tried on March 24, 1968 for the purpose of artificial interruption of pregnancy by a physician. Following this procedure massive hemorrhage was noted.
After admission the pelvic examination revealed the uterus was enlarged to the size of two months´ pregnancy-and non-tender. The cervix was enlarged and firm. The cervical os was slightly opened and dark hemorrhage was noted. Under the general anesthesia, abdominal total hysterectomy and right salpingo=oophorectomy were porformed.
Pathological examination: Gross findings; The specimen consisted of a totally removed uterus with right tube And ovary, weighing 125 Gm. On opening the uterus, the cervix was markedly enlarged and at the left part of the cervical canal firm, red darkish, bulging tissue, approximately 4.5×4.5×3.5 was noted. On hemisection, the hemorrhagic area invaded deep into the left cervical wall, of which the thinnest area measured approximately 0.1-0.2 Cm. (Fig. 5,6,7).
Microscopic examination; Section from the cervix showed necrotic blood clots, chorionic villi and trocells which invaded into the endocervical wall and were directly attached to the fibromuscular wall of the cervix (Fig. 8, 9).
Pathological diagnoses; Placenta cervicalis increta destruens, secretory endometrium, and corpus luteum of right ovary.

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