Imseis H M, Murtha A P, Alexander K A, Barnett B D
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
J Reprod Med. 1998 Mar;43(3):233-6.
Uterine rupture secondary to placenta percreta has been observed in multiparous patients. These cases are typically associated with a prior history of uterine trauma or infection: hysterotomy, myomectomy, cornual resection, dilatation and curettage, manual removal of the placenta or endometritis. Spontaneous rupture of the primigravid uterus without a history of trauma or infection is an exceedingly rare occurrence. This case represents the second reported in the medical literature and the first to result in a live-born infant.
A 23-year-old, African American primigravida at 26 weeks' gestation presented with acute-onset abdominal pain, severe hypotension, tachycardia and fetal heart rate decelerations. Blood product replacement was initiated, and an emergency laparotomy was performed for a presumptive diagnosis of intraabdominal hemorrhage. A significant hemoperitoneum was encountered, with the fetus floating freely in the peritoneal cavity. The uterus had a fundal rupture with a clinically apparent placenta percreta that necessitated performing a total abdominal hysterectomy. The patient recovered uneventfully, and the infant survived without significant morbidity.
Spontaneous rupture of the primigravid uterus can occur in the absence of a history of uterine trauma or infection. If a gravid woman presents with hypotension, abdominal pain and fetal distress, the differential diagnosis should include rupture of the uterus, regardless of parity or gynecologic history. Rapid diagnosis, blood product replacement and emergency laparotomy are the key steps in successful management.
经产妇中已观察到因穿透性胎盘植入导致的子宫破裂。这些病例通常与既往子宫创伤或感染史有关：子宫切开术、子宫肌瘤切除术、子宫角切除术、刮宫术、人工剥离胎盘或子宫内膜炎。初产妇子宫在无创伤或感染史的情况下自发破裂极为罕见。本病例是医学文献中报道的第二例，也是首例分娩活婴的病例。
一名23岁的非洲裔美国初产妇，孕26周，出现急性腹痛、严重低血压、心动过速和胎儿心率减速。开始进行血液制品置换，并进行急诊剖腹探查，初步诊断为腹腔内出血。术中发现大量腹腔积血，胎儿在腹腔内自由漂浮。子宫底部破裂，伴有临床明显的穿透性胎盘植入，遂行全腹子宫切除术。患者恢复顺利，婴儿存活，无明显并发症。
初产妇子宫可在无子宫创伤或感染史的情况下发生自发破裂。如果孕妇出现低血压、腹痛和胎儿窘迫，鉴别诊断应包括子宫破裂，无论其孕产次或妇科病史如何。快速诊断、血液制品置换和急诊剖腹探查是成功治疗的关键步骤。
