Reproductive Medicine Center, Ningbo Women and Children's Hospital, Ningbo City, Zhejiang Province, China.
Medicine (Baltimore). 2023 Dec 8;102(49):e36254. doi: 10.1097/MD.0000000000036254.
Uterine rupture (UR) during pregnancy is a serious obstetric complication. Here we report a case of spontaneous rupture in an unscarred uterus at 13 weeks of gestation after in vitro fertilization embryo transfer, which is not common in past references. Our focus is to understand the relationship between systemic lupus erythematosus (SLE) and UR.
A 33-year-old infertile woman with a history of SLE became pregnant after in vitro fertilization embryo transfer. She presented with sudden mental fatigue and dyspnea, accompanied by sweating, dizziness and lower abdominal pain at 13 weeks of gestation.
Blood analysis revealed anemia. Ultrasonography and plain computed tomography scan revealed intrauterine early pregnancy with effusion in pelvic and abdominal cavity. Laparotomy confirmed the diagnosis of UR.
The patient underwent emergency laparotomy. Upon surgery, multiple myometrium was weak with only serosal layer visible, and there was a 2.5 cm irregular breach with exposed placenta and villous tissue in the posterior wall of the uterus. After removing intrauterine fetus and repairing the breach, there was still persistent intraperitoneal hemorrhage. The patient underwent subtotal hysterectomy finally.
Postoperative recovery was uneventful. The patient was discharged on the 8th day after operation.
Combined efforts of specialists from ultrasound, imaging and gynecologist led to the successful diagnosis and management of this patient. We should be cautious about the occurrence of unscarred uterus rupture during pregnancy of the women with the disease of SLE and long-term glucocorticoid treatment. In IVF, we had better transfer one embryo for these patients with the history of SLE. Obstetricians should strengthen labor tests to detect early signs of UR of the patients with SLE and long term glucocorticoid treatment. Once UR is suspected, prompt surgical treatment is needed as soon as possible.
妊娠时子宫破裂（UR）是一种严重的产科并发症。在这里，我们报告了一例在体外受精胚胎移植后 13 周妊娠未产妇的自发性 UR 病例，这在以往的参考文献中并不常见。我们的重点是了解系统性红斑狼疮（SLE）与 UR 之间的关系。
一名 33 岁的不孕不育女性，患有 SLE，在体外受精胚胎移植后怀孕。她在妊娠 13 周时出现突然的精神疲劳和呼吸困难，伴有出汗、头晕和下腹痛。
血液分析显示贫血。超声和 CT 平扫显示宫腔内早孕，盆腔和腹腔内有积液。剖腹探查证实 UR 的诊断。
患者接受了紧急剖腹手术。术中发现子宫多处肌层薄弱，仅见浆膜层，子宫后壁有 2.5cm 不规则裂口，胎盘和绒毛组织外露。取出宫内胎儿并修补裂口后，仍有持续性腹腔内出血。最终患者行次全子宫切除术。
术后恢复顺利。患者术后第 8 天出院。
超声、影像和妇科专家的联合努力导致了该患者的成功诊断和治疗。对于患有 SLE 疾病和长期使用糖皮质激素治疗的孕妇，我们应该警惕未产妇子宫破裂的发生。对于有 SLE 病史的 IVF 患者，我们最好移植一个胚胎。产科医生应加强对有 SLE 病史和长期使用糖皮质激素治疗的孕妇的劳动试验，以检测 UR 的早期迹象。一旦怀疑 UR，应尽快进行手术治疗。
