Nakago Satoshi, Kato Hiroki, Shibata Takashi, Nishijima Koji, Kotsuji Fumikazu
Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan.
Department of Obstetrics and Gynecology, Niigata University Medical School, Niigata, Japan.
J Obstet Gynaecol Res. 2021 Mar;47(3):900-903. doi: 10.1111/jog.14604. Epub 2020 Dec 16.
Transverse uterine fundal incision (TUFI) was developed to avoid catastrophic hemorrhage associated with cesarean section of the placenta previa-accreta. Abdominal incisions extend as far as the upper abdomen in patients in the third trimester of pregnancy and require general anesthesia. Instead, we tried to aspirate amniotic fluid (AF) to reduce the uterine size.
TUFI was performed in 19 of our patients in the third trimester in whom placenta previa accreta could not be ruled out between June 2012 and August 2016. After the lower abdominal vertical incision, we attempted to exteriorize the uterine fundus. If this was impossible, we inserted an 18-gauge spinal needle into the amniotic space. We aspirated AF until the uterine fundus could be exteriorized.
We exteriorized the uterine fundus without extending the incision to the upper abdomen by aspirating 250-670 mL of AF in 12 patients who were between the 33rd and 37th week of pregnancy, and TUFI was performed under spinal anesthesia. AF aspiration was not required in four patients who were in the 30th or 31st week of pregnancy and in two patients with oligohydramnios in the 35th week of pregnancy. In one case, the trial was canceled due to hemorrhagic AF aspiration. No serious complications were observed in mothers or neonates.
TUFI could be made by abdominal incision to the left of the umbilicus under spinal anesthesia without anesthesia by reducing the uterine size through AF aspiration, even for patients in the third trimester of pregnancy.
横形子宫底部切口（TUFI）的设计是为了避免与前置胎盘植入剖宫产相关的灾难性出血。妊娠晚期患者的腹部切口会延伸至上腹部，且需要全身麻醉。相反，我们尝试抽吸羊水（AF）以减小子宫大小。
2012年6月至2016年8月期间，我们对19例妊娠晚期患者实施了TUFI，这些患者无法排除前置胎盘植入。在下腹部垂直切口后，我们试图将子宫底部娩出。如果无法做到这一点，我们将一根18号脊椎穿刺针插入羊膜腔。我们抽吸羊水，直到子宫底部能够娩出。
12例妊娠33至37周的患者通过抽吸250 - 670毫升羊水，在脊髓麻醉下未将切口延伸至上腹部就娩出了子宫底部，并实施了TUFI。4例妊娠30或31周的患者以及2例妊娠35周羊水过少的患者无需抽吸羊水。有1例因抽吸羊水时出血而取消了该尝试。未观察到母亲或新生儿出现严重并发症。
即使对于妊娠晚期患者，通过抽吸羊水减小子宫大小，可在脊髓麻醉下于脐左侧行腹部切口进行TUFI，无需全身麻醉。
