1例史蒂文斯-约翰逊综合征所致阴道狭窄患者的分娩途径及生殖器并发症管理综述
Route of Delivery in a Patient with Vaginal Stenosis from Stevens-Johnson Syndrome and Review of the Management of Genital Complications.
作者信息
Tsai Meng-Chen, Bai Geng-Hao, Au Heng-Kien
机构信息
Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
出版信息
Womens Health Rep (New Rochelle). 2024 Sep 6;5(1):658-662. doi: 10.1089/whr.2024.0074. eCollection 2024.
BACKGROUND
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatological conditions, predominantly affecting women with mortality rates of 4.8-48%. Antibiotics are common triggers. They cause painful mucous membrane erosions in various body parts. Treatment involves steroids, creams, and therapy. Pregnant women with SJS-related vaginal stenosis face challenges of delivery route.
CASE REPORT
A 34-year-old primigravida woman presented at term with vaginal stenosis consequent to a 10-year-history of Stevens-Johnson syndrome triggered by cephalosporin. On pediatric Pederson speculum examination, vaginal stenosis, adhesion, scarred cervix, telangiectasis of the vaginal mucosa, and moderate bleeding after examination were noted. The risks of severe genital tract laceration and excessive bleeding from vaginal birth was discussed with the couple. Shared clinical decision making was reached to undergo a cesarean delivery.
CONCLUSION
SJS and TEN can result in severe genital complications in women, sometimes requiring cesarean sections due to genital scarring.
背景
史蒂文斯 - 约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是严重的皮肤病，主要影响女性，死亡率为4.8% - 48%。抗生素是常见的诱因。它们会导致身体各部位出现疼痛性黏膜糜烂。治疗包括使用类固醇、乳膏和进行相关治疗。患有与SJS相关的阴道狭窄的孕妇面临分娩途径的挑战。
病例报告
一名34岁初产妇足月就诊，因头孢菌素引发的史蒂文斯 - 约翰逊综合征病史长达10年，导致阴道狭窄。经小儿Pederson阴道窥器检查，发现阴道狭窄、粘连、宫颈瘢痕化、阴道黏膜毛细血管扩张，检查后有中度出血。与这对夫妇讨论了经阴道分娩导致严重生殖道撕裂和大量出血的风险。共同做出临床决策，进行剖宫产。
结论
SJS和TEN可导致女性严重的生殖系统并发症，有时因生殖器瘢痕化需要进行剖宫产。
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