子宫内膜异位症疤痕——妊娠自发性血腹的潜在病因。
Endometriosis Scarring-A Potential Etiology for Spontaneous Hemoperitoneum in Pregnancy.
机构信息
Cleveland Clinic Women's Health Institute, Cleveland, OH.
Case Western Reserve University School of Medicine, Cleveland, OH.
出版信息
J Obstet Gynaecol Can. 2021 Aug;43(8):998-1000. doi: 10.1016/j.jogc.2021.03.013. Epub 2021 Mar 31.
BACKGROUND
Endometriosis is a common condition characterized by the accumulation of dense adhesions and scar tissue around the pelvic organs, which can lead to complications. Disruption of endometriotic scar tissue is rare but can lead to spontaneous intraperitoneal hemorrhage in pregnancy.
CASE
We present the case of a patient admitted for signs of labour at 40 weeks gestation. At emergency cesarean delivery for cord prolapse, the patient was found to have a massive intraperitoneal bleed. Mechanical disruption of endometriotic scar tissue during positioning for an epidural may have been the precipitating event, as the symptoms of spontaneous hemorrhage, including hypotension and pain, appeared immediately afterward.
CONCLUSION
Without the cord prolapse, cesarean delivery would have been delayed and the spontaneous hemorrhage might have been missed. This case report alerts obstetricians to have a high index of suspicion for spontaneous hemorrhage in pregnant patients with a history of advanced-stage endometriosis, as this event can be life-threatening to mother and baby.
背景
子宫内膜异位症是一种常见病症，其特征是盆腔器官周围积聚密集的粘连和疤痕组织，可能导致并发症。子宫内膜异位症疤痕组织的破裂很少见，但可能导致妊娠时自发性腹腔内出血。
病例
我们报告了一例患者，她在妊娠 40 周时因临产迹象入院。在行紧急剖宫产术以治疗脐带脱垂时，发现患者有大量腹腔内出血。硬膜外麻醉时的体位机械性破坏子宫内膜异位症疤痕组织可能是诱发事件，因为自发性出血的症状，包括低血压和疼痛，随后立即出现。
结论
如果没有脐带脱垂，剖宫产可能会被延迟，自发性出血可能会被忽视。本病例报告提醒产科医生，对于有晚期子宫内膜异位症病史的妊娠患者，要高度怀疑自发性出血，因为这种情况对母婴都有生命威胁。
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