Clinical And Ultrasonic Features Of Early Cornual Pregnancy And Tubal Interstitial Pregnancy

Objective: To explore the risk factors,clinical symptoms,two-dimensional and three-dimensional transvaginal ultrasonography features of early cornual pregnancy and tubal interstitial pregnancy,and to find the essentials for diagnosing and differentiating the two types of pregnancy.Method: A retrospective analysis was carried out on 35 cases of early cornual pregnancy and 43 cases of early tubal interstitial pregnancy with clinical data and ultrasonography data confirmed by hysteroscope,laparotomy and laparoscopic surgeries in the First Affiliated Hospital of Chengdu Medical College from September 2013 to September 2017,in order to recognize the risk factors,clinical symptoms,as well as two-dimensional and three-dimensional transvaginal ultrasonography features differentiated between early cornual pregnancy and early tubal interstitial pregnancy.Risk factors include assisted reproductive technology(ovulation drugs,IVF-ET),history of intrauterine operation(history of curettage,IUD placement,hysteroscopic surgery,and surgery of removing intrauterine adhesions),delivery(natural birth and cesarean birth),uterine malformation and inflammation(endometritis,salpingitis),pelvic operations(laparoscopic surgery and laparotomy),history of pelvic surgery(history of appendicitis surgery and ectopic pregnancy surgery).The clinical symptoms include the history of menopause(with/without),abdominal pain(with/without),vaginal bleeding(with/without).Two-dimensional transvaginal ultrasonography refers to the maximal diameter of gestational sac or masses(big / small),the gestational sac or mass protrusion(with / without),cornual and intrauterine morphology(symmetric / asymmetric),morphology of cornual muscularis(symmetric / asymmetric),position of gestational sac or mass(left / right),thickness of the muscularis surrounding thegestational sac or mass(thick / thin),boundary of gestational sac or mass(clear/ fuzzy),integrity of the muscularis surrounding the gestational sac or mass(complete / incomplete),whether there was endometrial and gestational sac or mass continuity(yes / no),interstitial linear syndrome(with/without)and mass morphology(regular/irregular).Three-dimensional transvaginal ultrasonography refers to gestational sac or mass protrusion(with/without),cornual bulge(with /without),thickness of the muscularis surrounding the gestational sac or mass(thick / thin),integrity of the muscularis surrounding the gestational sac or mass(complete / incomplete),whether there was endometrium wrapped around or close to the gestational sac or mass(yes / no),integrity of uterine cavity(complete or incomplete).Results: 1.Risk factors: statistical difference existed between early cornual pregnancy and early tubal interstitial pregnancy early in the history of curettage,endometritis and salpingitis(p<0.05);while there was no statistical difference in terms of ovulation drugs,IVF-ET technology,history of IUD placement and surgery of removing intrauterine adhesions,natural birth,cesarean birth,uterine malformation,laparoscopic surgery,laparotomy,appendicitis surgery,ectopic pregnancy surgery(p>0.05).2.Clinical symptoms:statistica difference existed between early cornual pregnancy and early tubal interstitial pregnancy in terms of vaginal bleeding(p<0.05);while there was no statistical difference in terms of menopause and abdominal pain(p>0.05).3.Two-dimensional transvaginal ultrasonography:(1)statistical difference existed between the gestational sac type of cornual pregnancy and the gestational sac type of tubal interstitial pregnancy in aspects of gestational sac protrusion,cornual and intrauterine morphology,thickness of peripheral muscularis,integrity of peripheral muscularis,whether there was endometrial continuity,interstitial linear syndrome(p<0.05),while there was no statistical difference in terms of the maximal diameter of gestational sac,sac position,morphology of cornual muscularis,and the boundary of gestational sac(p>0.05).(2)statistical difference existed between the mixed type of cornual pregnancy and the mixedtype of tubal interstitial pregnancy in terms of mass protrusion,cornual and intrauterine morphology,thickness of peripheral muscularis(p<0.05);while there was no statistical difference in terms of the maximal diameter of gestational mass,mass position,morphology of cornual muscularis,boundary of gestational mass,integrity of peripheral muscularis,whether there is endometrial continuity,interstitial linear syndrome,and mass morphology(p>0.05).4.Three-dimensional transvaginal ultrasonography: statistical difference existed between the gestational sac type and mixed type of cornual pregnancy and the gestational sac type and mixed type of tubal interstitial pregnancy in aspects of gestational sac or mass protrusion,thickness of peripheral muscularis,integrity of peripheral muscularis,whether there is endometrium wrapped around or close to the gestational sac or mass,and integrity of uterine cavity(p<0.05);while there was no statistical difference in terms of cornual bulge(p<0.05).Conclusion:(1)There is a difference in risk factors and clinical symptoms in cornual pregnancy and tubal interstitial pregnancy.(2)The diagnosis and differential diagnosis of two-dimensional vaginal ultrasonography in the mixed type of cornual pregnancy and the mixed type of tubal interstitial pregnancy were inadequate.Two-dimensional transvaginal ultrasonography can diagnose and differential diagnosis of the gestational sac type of cornual pregnancy and the gestational sac type of tubal interstitial pregnancy.(3)Three-dimensional transvaginal ultrasonography can diagnose and differential diagnosis of the gestational sac type and mixed type of cornual pregnancy and the gestational sac type and mixed type of tubal interstitial pregnancy.