Nel J T, Schaetzing A E
S Afr Med J. 1985 Aug 31;68(5):333-4.
A 20-year-old primigravida presented at 39 weeks' gestation with the fetus lying in the transverse position. Ultrasound examination indicated an anterior placenta praevia grade II-III. During a vertical lower uterine segment caesarean section, a giant intramural leiomyoma of approximately 25 X 25 cm was found. The uterine incision was extended into the upper segment and a healthy male fetus of 2 568 g delivered. The placenta was situated anteriorly but did not extend into the lower uterine segment. A myomectomy had to be performed to enable closure of the uterine incision. The association of a transverse lie with anterior implantation of the placenta may result in a false ultrasound diagnosis because the lower anterior portion of the uterine wall and the attached portion of the placenta simulate a placenta praevia. In our case, an unsuspected leiomyoma in the lower segment contributed to this. Furthermore, this case illustrates the advantage of using a lower uterine segment vertical incision when performing a caesarean section for transverse lie. The incision can then readily be extended into the upper uterine segment when necessary.
一名20岁初产妇在妊娠39周时就诊，胎儿为横位。超声检查显示前置胎盘II - III级。在子宫下段垂直剖宫产术中，发现一个约25×25 cm的巨大壁间肌瘤。子宫切口向上段延伸，娩出一名体重2568 g的健康男婴。胎盘位于前位，但未延伸至子宫下段。必须进行肌瘤切除术才能关闭子宫切口。横位与胎盘前位植入相关联可能导致超声误诊，因为子宫前壁下段和附着的胎盘部分模拟了前置胎盘。在我们的病例中，下段未被怀疑的肌瘤促成了这一情况。此外，该病例说明了在为横位行剖宫产时采用子宫下段垂直切口的优势。必要时，切口可轻松向上段延伸。
