Mayne Leah, Sudhahar Anusha, Veerasingham Mayooran
Department of Obstetrics and Gynaecology, Ipswich Hospital, Ipswich, Queensland, Australia.
Faculty of Medicine, Griffith University, Gold Coast, Queensland, Australia.
Case Rep Womens Health. 2021 May 1;31:e00320. doi: 10.1016/j.crwh.2021.e00320. eCollection 2021 Jul.
Intrapartum annular cervical tears are a rare pregnancy complication. The mechanisms underpinning these tears remain to be elucidated and currently the optimal management and future pregnancy implications remain unknown.
We present the case of a 35-year-old nulliparous woman who was diagnosed with a partial annular cervical tear following induction of labour. Her intrapartum course was also complicated by an intrapartum fever, prolonged labour induction and an antepartum haemorrhage. During the second stage of labour, a band of cervical tissue could be seen at the introitus and abutting the fetal head. Following normal vaginal delivery, a portion of cervical tissue was visualised, 2 cm thick by 5 cm long, avulsed at the lateral edge at 9 o'clock and extending in an annular anti-clockwise fashion towards 1 o'clock. She underwent surgical repair of the cervical tear and had an uneventful postnatal course. At 6 weeks post-partum her cervix appeared to be healing well with 2 cm length palpable on vaginal examination.
To the best of our knowledge, this case is the first report of a partial annular cervical tear to present in this manner. While the optimal management and outcomes for tears of this nature remain unknown, we recommend prenatal ultrasound cervical length screening with consideration of a cervical cerclage and elective caesarean section, which could avoid pre-term birth or the recurrence of this type of tear in future pregnancies.
产时宫颈环形撕裂是一种罕见的妊娠并发症。这些撕裂的潜在机制仍有待阐明，目前最佳的处理方法以及对未来妊娠的影响尚不清楚。
我们报告一例35岁未产妇，在引产过程中被诊断为部分宫颈环形撕裂。她的产时过程还并发了产时发热、引产时间延长和产前出血。在第二产程中，可见阴道口有一圈宫颈组织紧贴胎头。正常阴道分娩后，可见一部分宫颈组织，厚2厘米，长5厘米，在9点处的外侧边缘撕裂，并呈逆时针环形延伸至1点处。她接受了宫颈撕裂修补手术，产后过程顺利。产后6周，经阴道检查可触及宫颈长度为2厘米，宫颈愈合良好。
据我们所知，本病例是以这种方式出现的部分宫颈环形撕裂的首例报告。虽然这种性质的撕裂的最佳处理方法和结果尚不清楚，但我们建议进行产前超声宫颈长度筛查，并考虑行宫颈环扎术和选择性剖宫产，这可以避免早产或未来妊娠中此类撕裂的复发。
