Maki Jota, Mitoma Tomohiro, Mishima Sakurako, Ohira Akiko, Tani Kazumasa, Eto Eriko, Hayata Kei, Masuyama Hisashi
Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Case Rep Womens Health. 2021 Dec 14;33:e00375. doi: 10.1016/j.crwh.2021.e00375. eCollection 2022 Jan.
The incidence of severe uterine prolapse during childbirth is approximately 0.01%. Moreover, to the best of our knowledge, no reports detail the healing process of the cervix during uterine involution. This report describes successful vaginal delivery and the healing process of postpartum uterine prolapse and cervical tears in a patient with severe uterine prolapse.
A patient in her 40s (gravida 3, para 1, abortus 1) with severe uterine prolapse successfully delivered a live female baby weighing 3190 g at 38 + 5 weeks of gestation by assisted vaginal delivery. Uterine prolapse had improved to approximately 2° by 2 months postoperatively. On postpartum day 4, during the healing process of cervical laceration, the thread loosened in a single layer of continuous sutures due to uterine involution, and poor wound healing was observed. The wound was subsequently re-sutured with a two-layer single ligation suture (Gambee suture + vertical mattress suture). However, on postpartum day 11, a large thread ball was hindering the healing of the muscle layer, which improved with re-suturing.
Although vaginal delivery in a patient with severe uterine prolapse is possible in some cases, the cervix should be sutured, while considering cervical involution after delivery.
分娩期间严重子宫脱垂的发生率约为0.01%。此外，据我们所知，尚无报告详细描述子宫复旧过程中宫颈的愈合过程。本报告描述了一例严重子宫脱垂患者成功经阴道分娩以及产后子宫脱垂和宫颈撕裂的愈合过程。
一名40多岁（孕3产1流1）的严重子宫脱垂患者在妊娠38 + 5周时通过阴道助产成功分娩一名体重3190克的活女婴。术后2个月子宫脱垂改善至约Ⅱ度。产后第4天，在宫颈裂伤愈合过程中，由于子宫复旧，单层连续缝合的缝线松动，观察到伤口愈合不良。随后用双层单结扎缝合（加贝缝合 + 垂直褥式缝合）重新缝合伤口。然而，产后第11天，一个大线结阻碍了肌层愈合，重新缝合后情况有所改善。
虽然在某些情况下严重子宫脱垂患者经阴道分娩是可行的，但在考虑产后宫颈复旧的同时，应缝合宫颈。
