妊娠头三个月胎儿脐带破裂:病例报告和文献综述

S. Mutiso, Felix M Oindi, Debbie Mundia
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摘要

背景:子宫破裂是一种罕见的并发症,可发生在妊娠的前三个月。它可导致严重的孕产妇发病率或死亡率,主要是因为灾难性出血。妊娠头三个月子宫破裂非常罕见;因此,诊断可能具有挑战性,因为它可能与其他原因导致的早期妊娠出血(如宫外孕)相混淆。我们介绍了一例第一胎瘢痕开裂的病例,并对这一罕见病症进行了文献综述:一名 39 岁的患者曾有过 4 次子宫切除术疤痕,在妊娠 11 周时出现剧烈下腹痛。患者曾有两次妊娠第三胎子宫破裂的病史,随后进行了子宫切除和修补术。患者接受了诊断性腹腔镜检查,确诊为 10 厘米前壁子宫破裂。随后进行了开腹手术和破裂修补术。结论:本病例为妊娠头三个月子宫瘢痕开裂提供了更多证据。概述的风险因素、临床表现、影像诊断和处理方法可能有助于早期识别和处理这种罕见但危及生命的疾病。
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terine rupture in the first trimester: A case report and literature review
Background: Uterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, mostly because of catastrophic bleeding. First-trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding, such as an ectopic pregnancy. We present a case of first-trimester scar dehiscence and conduct a literature review of this rare condition. Case presentation: A 39-year-old patient with 4 previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. The patient had two previous histories of third-trimester uterine rupture in previous pregnancies with subsequent hysterotomy and repair. The patient underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently performed.  Conclusion: This case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The outline risk factors, clinical presentation, diagnostic imaging, and management may help in the early identification and management of this rare but life-threatening condition.   
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