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一例怀有致死性骨骼发育不良胎儿(致死性侏儒症)的初产妇足月时未瘢痕子宫自发性破裂。病例报告及文献复习

Spontaneous Rupture of Unscarred Uterus in a Term Primagravida with Lethal Skeletal Dysplasia Fetus (Thanatophoric dysplasia). A Case Report and Review of the Literature.

作者信息

Hussein Ahmed Issak, Omar Abdikarim Ali, Hassan Hodan Abdi, Kassim Mohamed Mukhtar, Yusuf Abdisalam Abdullahi, Osman Ahmed Adam

机构信息

Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia.

Pediatric Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia.

出版信息

Int Med Case Rep J. 2022 Oct 6;15:551-556. doi: 10.2147/IMCRJ.S383195. eCollection 2022.

Abstract

BACKGROUND AND IMPORTANCE

Spontaneous uterine rupture, especially in an unscarred uterus, is a rare pregnancy complication that can cause severe morbidity and mortality in both the mother and the fetus. The vast majority of uterine ruptures occur in the presence of a previous uterine scar, most commonly from a previous cesarean delivery. To our knowledge, here we reported the first case of spontaneous rupture of unscarred uterus in a term primigravida secondary to lethal skeletal dysplasia fetus (Type 1 Thanatophoric dysplasia) faced by a practicing clinician in an underdeveloped country (Somalia) with a successful outcome.

CASE PRESENTATION

The patient was 24 yrs. Old Primagravida, at 40 weeks gestation by LMP, presented with abdominal pain and active vaginal bleeding; she did not receive antenatal care during pregnancy; after initial abdominal ultrasonography and vaginal examination, laparotomy was performed due to high suspicion of uterine rupture. After dead fresh fetal extraction, the uterine defect was repaired successfully, and the patient was discharged home in good condition after several days.

CONCLUSION

Through this case, we would like to highlight the urgent need to focus on and recognize the importance of receiving antenatal care in the community so that the burden of thousands of lives lost each year can be reduced.

摘要

背景与重要性

自发性子宫破裂,尤其是在未受过损伤的子宫中发生,是一种罕见的妊娠并发症,可导致母亲和胎儿出现严重的发病率和死亡率。绝大多数子宫破裂发生在既往有子宫瘢痕的情况下,最常见于既往剖宫产术后。据我们所知,在此我们报告了在一个欠发达国家(索马里),一名执业临床医生所遇到的首例因致死性骨骼发育不良胎儿(1型致死性侏儒症)导致的足月初产妇未受过损伤的子宫自发性破裂病例,且结局成功。

病例介绍

患者为一名24岁的初产妇,根据末次月经计算孕周为40周,出现腹痛及阴道活动性出血;孕期未接受过产前检查;在最初的腹部超声检查及阴道检查后,由于高度怀疑子宫破裂而进行了剖腹探查术。娩出已死亡的新鲜胎儿后,成功修复了子宫缺损,数天后患者状况良好出院。

结论

通过该病例,我们想强调迫切需要关注并认识到在社区接受产前检查的重要性,以便减少每年数千人死亡的负担。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c06b/9549793/056e3822ea96/IMCRJ-15-551-g0001.jpg

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Int J Surg Case Rep. 2022 Mar;92:106840. doi: 10.1016/j.ijscr.2022.106840. Epub 2022 Feb 18.
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