既往有子宫内膜消融术史的女性发生胎盘植入和宫内胎儿死亡：一例病例报告。

Placenta accreta and intrauterine fetal death in a woman with prior endometrial ablation: a case report.

作者信息

Hoffman Matthew K, Sciscione Anthony C

机构信息

Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware 19801, USA.

出版信息

J Reprod Med. 2004 May;49(5):384-6.

PMID:15214713

Abstract

BACKGROUND

Few cases of pregnancy following endometrial ablation have been reported. Placenta accreta and poor perinatal outcome are potential risks due to underlying endometrial destruction and uterine scarring.

CASE

A 41-year-old, white woman presented for initial prenatal care at 12 weeks, 3 years after endometrial ablation with resection of a leiomyoma. The patient's prenatal care was unremarkable until 20 weeks, when she presented with intrauterine fetal death. Labor was induced with misoprostol, and a stillborn fetus resulted. The placenta failed to deliver spontaneously after 6 hours and continuing doses of misoprostol. An attempt at manual extraction failed to demonstrate a clear cleavage plane between the placenta and endometrium. The patient underwent a hysterectomy for placenta accreta, which was confirmed on pathology.

CONCLUSION

Endometrial ablation may predispose the patient to abnormal placentation and intrauterine fetal death. Physicians should counsel their patients appropriately about the likelihood of this outcome.

摘要

背景

子宫内膜切除术后妊娠的病例报道较少。由于潜在的子宫内膜破坏和子宫瘢痕形成，胎盘植入和围产期不良结局是潜在风险。

病例

一名41岁白人女性，在子宫内膜切除并切除平滑肌瘤3年后，于孕12周前来进行首次产前检查。该患者的产前检查直至孕20周都无异常，此时她出现了宫内胎儿死亡。使用米索前列醇引产，产出一死胎。6小时后胎盘未能自然娩出，继续给予米索前列醇。人工剥离胎盘的尝试未能显示胎盘与子宫内膜之间有清晰的剥离平面。该患者因胎盘植入接受了子宫切除术，病理检查证实了这一点。