穿透性胎盘植入合并自发性子宫破裂1例

子宫破裂的发生率圳内报道为1．4‰～5．5‰，国外报道为0．08‰～10‰。穿透性胎盘植入合并自发性子宫破裂在临床上罕见，现将我们收治1例报告如下：     

中期妊娠穿透性胎盘植入致子宫破裂成功诊治1例

<正>子宫破裂是指在妊娠晚期或分娩期子宫体部或子宫下段发生破裂,是直接危及产妇及胎儿生命的严重并发症[1]。其主要原因包括子宫手术史、既往剖宫产史、胎盘植入、子宫畸形及外伤等,常与既往有剖宫产史密切相关,既往无剖宫产史而出现自发子宫破裂极少见,其发生率低于1/10 000[2-3]。现报道川北医学院附属医院收治的1例既往无剖宫产史但合并穿透性胎盘植入引起子宫破裂的病例资料,探讨其发病原因、诊断和治疗方法,为临床诊疗提供参考。1 病例介绍     

晚孕胎盘植入引产致子宫破裂一例

子宫破裂是产科最严重的并发症之一,近年来随着医学事业的发展及母婴保健法的具体实施,城市及发达地区发生极少,而边远山区基础医疗条件差,子宫破裂仍有发生。本院曾收治晚孕胎盘植入引产不当致子宫破裂抢救成功一例,报道如下：     

穿透性胎盘植入致子宫破裂误诊1例

1临床资料 患者,31岁,G4P1,因停经33周,持续性下腹痛5h于2006年2月3日急诊入院。既往体健,足月顺产1次;终止妊娠1次,因胎盘残留致宫腔感染,此次妊娠清宫2次;人工流产1次。本次妊娠经过顺利,无阴道出血史,发病前无创伤，无性生活史，呕吐胃内容物1次。体格检查：T36．6℃，呼吸20次／min，脉搏80次／min，血压100／70mmHg（1mmHg=0．133kPa）心肺无异常；     

穿透性胎盘植入致子宫破裂二例报告

胎盘植入是产科少见而危重的并发症,O'Brie等[1]报道发病率为1/7 000～1/540.穿透性胎盘致子宫破裂则更罕见,我院2006年1月至2011年8月共分娩48 000例,仅发现2例穿透性胎盘植入子宫破裂.穿透性胎盘植入如处理不及时,很可能需子宫切除甚至危及患者生命.     

孕中期引产胎盘植入致子宫破裂死亡1例分析

病历资料 患者，女，40岁，因停经24^＋2周，要求终止妊娠，于2009年2月6日入院。入院的诊断为孕6产2，孕24^＋2周。该患者既往曾足月自然分娩2次，孕中期引产3次，3次引产时均行刮宫术。入院后体检必要辅助检查，无利凡诺经腹羊膜腔注射引产禁忌，于当日下午15：00行利凡诺100mg经腹羊膜腔注射引产术，过程顺利，术后观察30分无不适安返病房。     

膝胸卧位致晚孕子宫破裂1例报告

患者，２７岁，孕２产１，妊娠３２＋５周，横位，膝胸卧位１周，突然下腹部持续性疼痛，进行性加重６ｈ伴恶心、呕吐，呕吐物为胃内容物，昏倒１次，急来我院急诊科按急腹症抢救治疗症状无好转，经妇产科会诊，考虑为子宫破裂，胎死宫内收住院。查体：Ｔ３７℃，Ｐ１１５次／ｍｉｎ，Ｒ２５次／ｍｉｎ，ＢＰ８／４ｋＰａ，神志清，精神差，急性失血面容。双肺呼吸音清晰，未闻及干湿性罗音。心音低钝，律齐，心率１１５次／ｍｉｎ，各瓣膜听诊区未闻及病理性杂音。腹膨隆，腹肌紧张，全腹压痛，反跳痛均阳性，移动性浊音阳性。产科检查：宫…     

晚期妊娠胎盘植入致完全性子宫破裂1例

晚期妊娠胎盘植入致完全性子宫破裂１例毕艳春，杜秀英，徐东霞（东营胜利石油管理局胜利医院，２５７０５５）关键词晚期妊娠，胎盘植入，子宫破裂患者３２岁。因停经３０周，上腹部疼痛伴恶心呕吐１２小时，于１９８９年９月４日晚１２时以“急性阑尾炎”收入外科。患者...     

妊娠子宫破裂胎盘植入腹腔1例

<正>胎盘植入是产科严重的并发症之一,产前很难诊断,处理不及时可导致弥散性血管内凝血DIC,危及产妇生命。近年由于不良孕产史发生率增加,胎盘植入的发生率呈上升趋势,因此,搞好计划生育宣传、普及节育知识、指导正确避孕,减少计划外妊娠、注意宫腔手术的无菌操作、提高手术质量是降低胎盘植入发病率的重要措施,加强孕产期保健,定期产前检查,对预防子宫破裂胎盘植入具有重要意义,应引起医务人员的高度重视。     

穿透性胎盘致子宫破裂一例报告

患者25岁,病案号03535。因“孕38周G2P0,未感觉到胎动一天”于2004年12月15日急诊入我科。末次月经2004年3月23日,预产期2004年12月30日。停经40天余查尿HCG（＋）,诊断为“早孕”,孕5月自感胎动,定期检查无异常。患者曾于2003年2月因“早孕”行人工流产术。入院查体：体温36．TC,脉搏110次／分,血压110mmHg／70mmHg,神智清楚,无贫血貌,腹隆,耻骨联合上轻压痛,     

Acute abdomen and massive hemorrhage due to placenta percreta leading to spontaneous uterine rupture in the second trimester

Placental invasion anomalies are rare obstetrical complications. They cause severe third trimester hemorrhage, severe postpartum bleeding, and maternal morbidity and mortality unless they are diagnosed antenatally. We present a rare case with placenta percreta leading to spontaneous uterine rupture during the second trimester with an acute abdomen and hypovolemia.Placental invasion anomalies refer to the abnormal adherence of the placenta to the uterine wall, resulting in detachment failure after delivery.1 They are classified according to invasion depth. Placenta accreta occurs if the villi penetrates the decidua but not myometrium, placenta increta occurs if the villi penetrate the myometrium, and placenta percreta occurs if these villi perforate the serosa and also sometimes into adjacent organs such as the bladder.2 The prevalence is approximately one in 2,500 pregnancies. However, placenta previa raises the risk more than 10 times.3 The most frequent predisposing factors are prior cesarean operations and placenta previa. The worldwide increase in cesarean operations has raised the prevalence of placental invasion anomalies.4 Abnormal placentation is a serious obstetrical complication due to severe bleeding, which can cause shock and maternal mortality even in developed countries.5 Our case with uterine rupture due to placenta percreta during the second trimester is a rare, but life-threating complication. Its exact incidence is not known, because there are only a few isolated case reports in the literature. In this paper, we present this unusual case, followed by a brief review of the published data.     

植入性胎盘穿透致子宫破裂2例临床分析

目的探讨植入性胎盘穿透致子宫破裂的诊断和治疗。方法对近期我院收治的2例植入性胎盘穿透导致子宫破裂的患者的临床资料进行回顾性分析,并复习相关文献。结果2例患者均行急诊剖腹探查术,术中均发现大量腹腔内出血,胎盘植入至子宫浆膜层并导致子宫破裂出血。对两患者分别行次全子宫切除术和子宫楔型切除＋修补术,均取得良好治疗效果。结论对有植入性胎盘高危因素的患者应加强产前检查,提高产前诊断率。对可疑患者应尽快行剖腹探查术,术中根据胎盘植入面积大小、失血量多少和是否有生育要求采取不同的治疗方法。     

Placenta percreta with painless uterine rupture at the 2nd trimester

A pregnant lady at 27 weeks and 2 days gestation with a known placenta previa major and a history of previous lower segment cesarean section had a sudden severe painless vaginal bleeding. At laparotomy a uterine rupture was noted, no hemoperitoneum found and placenta percreta was diagnosed. This is the first case reported in the Kingdom of Saudi Arabia, it is rare, only 3 cases of silent or asymptomatic uterine rupture secondary to placenta percreta were reported in the literature in the last 30-years. Non-invasive methods could help in the diagnosis or increase suspicion of placenta percreta, therefore, proper management could be arranged through a multi-disciplinary team.     

Asymptomatic rupture of the uterus: a case report

Rupture of the gravid uterus is a serious obstetric emergency that threatens maternal and fetal life. In certain cases the classic clinical picture may be absent. Most asymptomatic ruptures are in the lower segment and of minor extent or are really dehiscences of scars. This paper presents a case of massive spontaneous rupture involving the entire corpus diagnosed at elective postpartum sterilization. This unusual event stimulated a review of the causes and clinical presentations of uterine rupture.     

选择性血管阻断技术在妊娠晚期穿透性胎盘治疗中的应用价值

目的：探讨选择性血管阻断技术在妊娠晚期穿透性胎盘治疗中应用的价值。方法：回顾性分析2003年1月至2010年12月中南大学湘雅医院明确诊断的孕龄≥34周的15例穿透性胎盘患者的临床资料。根据患者是否使用血管阻断技术,分为血管阻断组(n=8)与血管未阻断组(n=7);血管阻断组按血管阻断技术应用的时机,又分为预防性应用组(n=4)和治疗性应用组(n=4,其中1例为髂总动脉球囊取出后)。比较血管阻断组与血管未阻断组出血量、子宫切除率及并发症发生情况。结果：15例穿透性胎盘患者术中平均出血量为3813 mL,子宫切除率为73.3%(11/15),近期并发症发生率为20.0%(3/15,包括2例凝血功能障碍和1例下肢血栓形成),远期并发症的发生率为0;其中血管阻断组平均出血量为2512 mL,子宫切除率为62.5%(5/8);血管未阻断组平均出血量5549 mL,子宫切除率85.7%(6/7);两组平均出血量及子宫切除率相比差异均有统计学意义(P<0.05)。且预防性应用组的平均出血量和子宫切除率亦显著低于治疗性应用组(1350 mL vs 3600 mL,60.0%vs 66.7%,P<0.05)。结论：穿透性胎盘患者术中出血量大,子宫切除率高;选择性血管阻断技术可减少其出血量,降低子宫切除率,但仍有严重出血以及切除子宫的风险。     

超声诊断膀胱自发性破裂1例

膀胱破裂分为腹膜内型和腹膜外型,作为一种外科急腹症,必须及时作出正确诊断,我科超声诊断自发性膀胱破裂1例,报道如下。1资料患者男,43岁,因持续性下腹部疼痛2 h后腹痛加剧难忍来我院就诊,追问病史,患者于醉酒后醒来8 h觉有尿意,但排尿费力,用力排尿时未能排出尿液,否认既往泌尿系统疾病、外伤史。查体：急性痛苦