背景:临床上无症状的子宫破裂伴胎儿完全排入腹腔是一种极为罕见的并发症。诊断可能很困难,对母亲和胎儿的风险很高。到目前为止,仅在少数胎儿部分排出的情况下描述了保守管理。
方法:我们介绍了一例43岁的子宫肌瘤患者,既往有开腹子宫肌瘤切除术和剖宫产术。子宫肌瘤切除术和胎儿完全排入腹腔后,先前子宫瘢痕部位的子宫壁松动和破裂使随后的妊娠变得复杂。诊断是在妊娠24+6周做出的。考虑到没有临床症状和胎儿的良好状况,我们选择了一种保守的方法,对母体和胎儿的病情进行密集监测.妊娠28+0周,择期剖宫产和子宫切除术结束妊娠。产后过程顺利,新生儿在分娩后63天出院接受家庭护理。
结论:瘢痕子宫无症状性子宫破裂后胎儿排入腹腔可能伴有轻微症状,难以早期诊断。在子宫大手术后的女性鉴别诊断中必须考虑这种罕见的并发症。在选定的病例中,在加强母婴监测的条件下,可以选择保守的管理来降低与早产相关的风险。
BACKGROUND: Clinically silent uterine rupture with complete fetal expulsion into the abdominal cavity is an extremely rare complication. Diagnosis can be difficult and the risk to the mother and fetus is high. Conservative management has been described only in a few cases of partial expulsion of the fetus so far.
METHODS: We present a
case of 43-year-old tercigravida with a history of previous laparotomic myomectomy and subsequent cesarean section. The subsequent pregnancy was complicated by uterine wall loosening and rupture at the site of the previous uterine scar after myomectomy and complete fetal expulsion into the abdominal cavity. The diagnosis was made at 24 + 6 weeks of gestation. Considering the absence of clinical symptomatology and the good condition of the fetus, a conservative approach was chosen with intensive monitoring of the maternal and fetal conditions. The pregnancy ended by elective cesarean section and hysterectomy at 28 + 0 weeks of gestation. The postpartum course was uneventful and the newborn was discharged to home care 63 days after delivery.
CONCLUSIONS: Fetal expulsion into the abdominal cavity after silent uterine rupture of the scarred uterus may be accompanied by minimal symptomatology making early diagnosis difficult. This rare complication must be considered in the differential diagnosis in women after major uterine surgery. In selected cases and under conditions of intensive maternal and fetal monitoring, conservative management may be chosen to reduce the risks associated with prematurity.