Stanford University School of Medicine, Stanford, California, USA
Obstetrics & Gynecology, Santa Clara Valley Medical Center, San Jose, California, USA.
BMJ Case Rep. 2021 Jan 29;14(1):e239872. doi: 10.1136/bcr-2020-239872.
A 31-year-old G3P2002 with history of two prior caesarean sections presented with influenza-like illness, requiring intubation secondary to acute respiratory distress syndrome. Investigations revealed intrauterine fetal demise at 30-week gestation.She soon deteriorated with sepsis and multiple organs impacted. Risks of the gravid uterus impairing cardiopulmonary function appeared greater than risks of delivery, including that of uterine rupture. Vaginal birth after caesarean was achieved with misoprostol and critical care status rapidly improved.Current guidelines for management of fetal demise in patients with prior hysterotomies are mixed: although the American College of Obstetricians and Gynecologists recommends standard obstetric protocols rather than misoprostol administration for labour augmentation, there is limited published data citing severe maternal morbidity associated with misoprostol use. This case report argues misoprostol-augmented induction of labour can be a reasonable option in a medically complex patient with fetal demise and prior hysterotomies.
一位 31 岁的 G3P2002 患者，有两次剖宫产史，因急性呼吸窘迫综合征需要插管，表现为流感样疾病。检查发现她在 30 孕周时宫内胎儿死亡。她很快因脓毒症和多个器官受累而病情恶化。妊娠子宫影响心肺功能的风险似乎大于分娩的风险，包括子宫破裂的风险。米索前列醇用于经剖宫产再次妊娠的阴道分娩，重症监护状态迅速改善。对于有剖宫产史的胎儿死亡患者，目前的管理指南存在分歧：虽然美国妇产科医师学会建议采用标准产科方案，而不是米索前列醇来促进产程进展，但发表的有限数据表明米索前列醇的使用与严重的产妇发病率相关。本病例报告认为，对于存在胎儿死亡和剖宫产史的复杂医疗患者，米索前列醇增强的引产可以是一个合理的选择。
