Yazawa Hiroyuki, Endo Sumiko, Hayashi Syoutaro, Suzuki Satoshi, Ito Akiko, Fujimori Keiya
Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital, Fukushima, Japan.
J Obstet Gynaecol Res. 2011 May;37(5):452-7. doi: 10.1111/j.1447-0756.2010.01361.x. Epub 2011 Jan 5.
Although a uterine leiomyomectomy or adenomyomectomy is an accepted procedure to treat symptoms such as dysmenorrhea or hypermenorrhea to enhance fertility, the risk of future uterine rupture is a major concern for patients who become pregnant following these surgery. Although uterine rupture very rarely occurs, this is the most feared complication in pregnancy and is associated with a high rate of maternal and fetal morbidity and mortality. A 37-year-old nulliparous woman had a 2-year history of infertility. A transvaginal ultrasound revealed multiple uterine tumors that resembled leiomyomas on the posterior and fundal walls of the uterine body. After the patient had three failed in vitro fertilization and embryo transfer treatments, the uterine tumor was enucleated, and pathologically diagnosed as an adenomatoid tumor. Five months after the operation, the patient became pregnant as a result of a fourth in vitro fertilization and embryo transfer. At the 33rd week of gestation, she complained of a sudden onset of abdominal pain. The patient was diagnosed with a ruptured uterus based on an ultrasound, and an emergency cesarean section was performed. The rupture occurred at the site of the operation scar on the posterior wall of the uterine body. The fetal legs extruded into the abdominal cavity from the uterine cavity but were enclosed within the unruptured chorioamniotic membrane. A male neonate (1956 g) was delivered without asphyxia and had Apgar scores of 8 and 9. The ruptured uterine wall could be repaired by suturing. To our knowledge, this is the first case report of uterine rupture during pregnancy after resection of an adenomatoid tumor in the uterine body.
尽管子宫平滑肌瘤切除术或子宫腺肌瘤切除术是治疗痛经或月经过多等症状以提高生育能力的一种公认手术，但对于接受这些手术后怀孕的患者来说，未来子宫破裂的风险是一个主要担忧。虽然子宫破裂非常罕见，但这是妊娠中最可怕的并发症，且与母婴高发病率和死亡率相关。一名37岁未生育女性有2年不孕史。经阴道超声检查发现子宫体后壁和底部有多个类似平滑肌瘤的子宫肿瘤。该患者在三次体外受精和胚胎移植治疗失败后，进行了子宫肿瘤摘除术，病理诊断为腺瘤样肿瘤。术后五个月，患者因第四次体外受精和胚胎移植而怀孕。妊娠第33周时，她主诉突发腹痛。根据超声检查，患者被诊断为子宫破裂，并进行了紧急剖宫产。破裂发生在子宫体后壁手术瘢痕处。胎儿腿部从子宫腔挤出进入腹腔，但被包裹在未破裂的羊膜绒毛膜内。一名男婴（1956克）顺利娩出，无窒息，阿氏评分分别为8分和9分。破裂的子宫壁可通过缝合修复。据我们所知，这是首例关于子宫体腺瘤样肿瘤切除术后妊娠期间子宫破裂的病例报告。
