Sakai Atsuhiko, Fujita Yasuyuki, Yumoto Yasuo, Fukushima Kotaro, Kobayashi Hiroaki, Wake Norio
Department of Obstetrics and Gynecology, Kyushu University Hospital, Fukuoka, Japan.
J Obstet Gynaecol Res. 2013 Jan;39(1):371-4. doi: 10.1111/j.1447-0756.2012.01967.x. Epub 2012 Jul 29.
A 29-year-old woman was diagnosed with a cervico-isthmic pregnancy based on ultrasound findings at 8 weeks of gestation. At 30 weeks of gestation, placenta previa was confirmed. During cesarean section at 37 weeks, the placenta did not spontaneously detach from the uterus; therefore, we decided to leave it in the uterus to avoid major hemorrhage. Blood loss was 775 mL and a healthy infant was delivered. After the operation, weekly methotrexate injection was initiated. Shortly after the eighth course of injection, massive vaginal bleeding suddenly occurred and bilateral uterine artery embolization was performed to control it. After the procedure, the retained placental tissue was removed and the patient was discharged with good general condition. Although a cervico-isthmic pregnancy constitutes a high-risk pregnancy, fertility-sparing management without a hysterectomy or blood transfusion was possible by not removing the placenta manually during the operation.
一名29岁女性在妊娠8周时经超声检查被诊断为宫颈峡部妊娠。妊娠30周时，确诊为前置胎盘。在37周剖宫产时，胎盘未自行从子宫剥离；因此，我们决定将其留在子宫内以避免大出血。失血775毫升，娩出一名健康婴儿。术后开始每周注射甲氨蝶呤。在第八疗程注射后不久，突然发生大量阴道出血，遂行双侧子宫动脉栓塞术以控制出血。术后，取出残留的胎盘组织，患者出院时一般情况良好。尽管宫颈峡部妊娠属于高危妊娠，但通过术中不手动剥离胎盘，有可能在不进行子宫切除术或输血的情况下进行保留生育功能的处理。
