Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Ultrasound Obstet Gynecol. 2022 Mar;59(3):398-399. doi: 10.1002/uog.23727. Epub 2022 Feb 7.
An asymptomatic 25-year-old G4P0120 with history significant for cervical insufficiency and classical cesarean delivery 12.5 months prior to conception underwent routine transabdominal ultrasound at 36w4d; umbilical cord was found to be protruding into a fluid-filled pouch extruding from the lower uterine segment. During emergent cesarean delivery, a full-thickness uterine rupture was confirmed; the fetal cranium and umbilical cord were extrauterine. Maternal genotype revealed greater than expected minor allele frequencies for several collagen genes. Maternal gene expression (mRNA) and corresponding microRNA expression of these collagen genes differed several-fold between her G3 (cervical insufficiency, classical cesarean delivery) and G4 (uterine rupture) pregnancies. This case highlights that (1) cervical insufficiency, poor myometrial wound healing, and uterine rupture may co-occur and pathophysiology may be related to collagen abnormalities and (2) asymptomatic uterine rupture can be detected sonographically, even in late pregnancy. Clinicians should remain vigilant for the possibility of uterine rupture, particularly among high-risk patients.
一位无症状的 25 岁 G4P0120 患者，既往有宫颈机能不全病史，12.5 个月前因经典剖宫产妊娠，在 36w4d 行常规经腹超声检查；发现脐带突入从下段子宫突出的充满液体的袋中。在紧急剖宫产时，证实为全层子宫破裂；胎儿头和脐带位于子宫外。母体基因型显示几个胶原基因的小等位基因频率高于预期。这些胶原基因的母体基因表达（mRNA）和相应的 microRNA 表达在她的 G3（宫颈机能不全，经典剖宫产）和 G4（子宫破裂）妊娠之间相差数倍。该病例提示：（1）宫颈机能不全、不良的子宫肌层愈合和子宫破裂可能同时发生，其病理生理学可能与胶原异常有关；（2）即使在妊娠晚期，也可以通过超声检测到无症状性子宫破裂。临床医生应警惕子宫破裂的可能性，尤其是在高危患者中。
