子宫破裂后胎盘植入合并可存活孕周前妊娠的成功管理
Successful Management of a Periviable Pregnancy with Morbidly Adherent Placenta after Uterine Rupture.
作者信息
Haidar Ziad A, Vowels Patricia C, Moussa Hind N, Sibai Baha M
机构信息
UT Health, McGovern Medical School at Houston, Houston, TX.
出版信息
J Obstet Gynaecol Can. 2016 Aug;38(8):719-22. doi: 10.1016/j.jogc.2016.03.014. Epub 2016 Jun 1.
BACKGROUND
Although rare, trauma in pregnancy can cause uterine rupture. In a periviable pregnancy, uterine rupture can lead to premature delivery and significant morbidity.
CASE
A 29-year-old woman with four prior CSs presented with uterine rupture and a protruding morbidly adherent placenta at 23+4 weeks of gestation. Since the pregnancy was highly desired, the defect was repaired and the decision made to continue with the pregnancy. The patient presented at 29+3 weeks of gestation with preterm labour and subsequently delivered a healthy male infant of 1130 grams.
CONCLUSION
Expectant management followed by CS can be beneficial in certain cases of uterine rupture with morbidly adherent placenta following trauma. This is especially the case in a periviable pregnancy, since prolonging the pregnancy will improve neonatal outcomes. We recommend individualized management based on clinical presentation, imaging findings, and the patient's wishes.
背景
尽管妊娠创伤罕见，但可导致子宫破裂。在可存活孕周前的妊娠中，子宫破裂可导致早产及严重并发症。
病例
一名有4次剖宫产史的29岁女性，在妊娠23⁺⁴周时发生子宫破裂，伴有胎盘植入且胎盘突出。由于该妊娠为强烈期待妊娠，故修补子宫缺损并决定继续妊娠。患者在妊娠29⁺³周时出现早产，随后分娩出一名体重1130克的健康男婴。
结论
对于创伤后伴有胎盘植入的子宫破裂某些病例，期待治疗后行剖宫产可能有益。在可存活孕周前的妊娠中尤其如此，因为延长孕周将改善新生儿结局。我们建议根据临床表现、影像学检查结果及患者意愿进行个体化处理。
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