Suwannarurk Komsun, Pongrojpaw Densak, Manusook Sakol, Suthiwartnarueput Worapop, Bhamarapravatana Kornkarn
J Med Assoc Thai. 2014 Aug;97 Suppl 8:S208-12.
Uterine rupture was a common occurrence at previously cesarean-sectioned scar Early sign ofuterine rupture was a severe fetal bradycardia.
A 30-year-old, 3 gravida, 1 para woman was presented with an acute abdominal pain and hypovolemic shock. Her gestational age was estimated at 18 weeks by emergency pelvic ultrasound. She had a lower segment scar from a previous caesarean section. Initially, alive intrauterinepregnancy with massive hemoperitoneum was a provisional diagnosis. During exploratory laparotomy, a ruptured of the right uterine fundus was found with placenta percreta. Hysterectomy was performed. Fetal weight was 450 grams, APGAR score 0, 0 and the fetus could not survive. The patient was discharged on the 4th day after surgery in healthy condition.
Uterine rupture is a catastrophic kituation. Severefetal bradycardia might be an early sign. This case demonstrates the importance ofclinical judgment based on clinical acumen.
子宫破裂在既往剖宫产瘢痕处较为常见。子宫破裂的早期迹象是严重的胎儿心动过缓。
一名30岁、孕3产1的女性因急性腹痛和低血容量性休克就诊。经急诊盆腔超声检查，估计其孕周为18周。她既往有剖宫产史，子宫下段有瘢痕。初步诊断为宫内活胎伴大量腹腔内出血。在剖腹探查术中，发现右子宫底部破裂并伴有穿透性胎盘植入。遂行子宫切除术。胎儿体重450克，阿氏评分0分、0分，胎儿未能存活。患者术后第4天健康出院。
子宫破裂是一种灾难性情况。严重的胎儿心动过缓可能是早期迹象。本病例说明了基于临床敏锐度进行临床判断的重要性。
