疤痕子宫产前出血可能是子宫动脉瘤的潜在危险信号（英文）

发布时间：2018-04-17 00:10

本文选题：子宫动脉瘤 + 经阴分娩　；参考：《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》2017年05期

【摘要】：目的:子宫动脉瘤多被认为与产程中创伤性操作相关,但近年陆续有报道显示子宫动脉瘤可发生于自然分娩过程中。本文将为自然分娩过程中子宫动脉瘤的发生和紧急处理等提供参考指导。创新点:产前出血可能是子宫动脉瘤发生的潜在危险信号。方法:病例报道和文献汇纳分析。患者女,37岁,疤痕子宫,临产入院,产前出血,经阴顺产后12 h,突发阴道大量出血,常规对症处理(按摩子宫、阴道填塞、缩宫素静滴和欣母佩宫颈注射等)未能有效缓解,40 min内出血达1800 ml。床边B超未提示动脉瘤特征,数字减影血管造影(DSA)显示左侧子宫动脉瘤,即刻予动脉栓塞成功止血。患者产后4 d无并发症出院,随访无后遗症。结论:临床医师需要加强对子宫动脉瘤发生的警惕认识和急救处理水平。子宫动脉瘤和产程中的有创性操作无必然相关性,疤痕子宫的产前出血可能是子宫动脉瘤发生的潜在危险信号,产后随访应提高对晚期出血发生的警惕性。鉴于B超在诊断动脉瘤方面的有限性,高度怀疑动脉瘤时应尽快行血管造影明确诊断,及时栓塞处理。
[Abstract]:Objective: uterine aneurysms are thought to be related to traumatic operation during labor, but there have been reports in recent years that uterine aneurysms can occur during natural labor.This article will provide reference for the occurrence and emergency management of uterine aneurysm during natural delivery.Innovation: prenatal bleeding may be a potential risk signal for uterine aneurysms.Methods: case report and literature analysis.The patient was 37 years old, with scar uterus, parturient, prenatal bleeding, 12 hours after vaginal delivery, sudden massive vaginal bleeding, routine treatment (massage uterus, vaginal tamponade, vaginal tamponade, vaginal tamponade),The intrauterine bleeding of 40 min could not be effectively alleviated by oxytocin intravenous drip and cervix injection.The left uterine aneurysm was demonstrated by digital subtraction angiography (DSAA) without any sign of aneurysm on the side of the bed. The embolization of the left uterine artery was performed immediately.There were no complications and no sequelae after 4 days postpartum.Conclusion: clinicians should strengthen their awareness of the occurrence of uterine aneurysms and the level of emergency treatment.There is no necessary correlation between invasive operation of uterine aneurysm and labor process. Prenatal bleeding of scar uterus may be a potential risk signal for the occurrence of uterine aneurysm. Postpartum follow-up should increase vigilance against late bleeding.In view of the limitation of B-ultrasound in the diagnosis of aneurysms, angiography should be performed as soon as possible, and embolization should be carried out as soon as possible when the aneurysms are highly suspected.
【作者单位】： Department
【基金】：supported by the Natural Science Foundation of Science and Technology Commission of Shanghai Municipality(No.16ZR1420000),China
【分类号】：R714.2

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