妊娠晚期子宫嵌顿一例

doi:10.12280/gjfckx.20231112

摘要/Abstract

摘要：

妊娠子宫嵌顿（incarceration of the gravid uterus，IGU）是一种罕见且严重的妊娠并发症，无特异性的临床表现。IGU可导致盆腔结构扭曲，于妊娠晚期行超声检查时易被误诊为前置胎盘，诊治不及时、不明确时可导致自然流产、早产、子宫破裂等不良妊娠结局。回顾分析1例妊娠晚期子宫嵌顿的病例。该病例无特异性临床表现，妊娠晚期常规产前彩色超声检查时被发现，收入院后于孕36周行剖宫产术终止妊娠，术中探查及术后病理明确了本例IGU是由于子宫底部腺肌瘤与周围组织形成了粘连，使子宫底部固定不能随妊娠周数的增长而延伸。本例母儿结局良好。分析总结IGU发病的高危因素、临床表现、影像学表现及治疗经验等，提高临床医师对该疾病的认识，降低IGU的漏诊率及误诊率，以改善妊娠结局。

关键词: 妊娠末期, 子宫后倾, 妊娠并发症, 平滑肌瘤, 妊娠子宫嵌顿

Abstract:

Incarceration of the gravid uterus (IGU) is a rare and serious pregnancy complication, without specific clinical manifestations. IGU can causes distortion of the pelvic structures, and can be easily misdiagnosed as placenta previa during late-pregnancy ultrasound examination. Inadequate diagnosis and treatment of this disease can lead to adverse pregnancy outcomes such as spontaneous abortion, preterm labor, and uterine rupture. This paper retrospectively analyzes a late-pregnancy case of IGU. The case had no specific clinical presentation and was detected during a routine prenatal ultrasound performed in late trimester of pregnancy. The patient underwent a cesarean section at 36 weeks of gestation, and intraoperative exploration and postoperative pathology clarified that IGU was caused by adhesions between an adenomyoma at the base of the uterus and surrounding tissues, restricting the expansion of the uterine fundus as pregnancy progressed. In this case, the mother and baby had favorable outcomes. This paper summarizes the risk factors, clinical presentation, imaging manifestations, and treatment experience of IGU, in order to improve clinicians′ understanding of the disease, reduce misdiagnosis and missed diagnosis of IGU, and improve pregnancy outcomes.

Key words: Pregnancy trimester, third, Uterine retroversion, Pregnancy complications, Leiomyoma, Incarceration of the gravid uterus

张亚楠, 赵峰, 江洪. 妊娠晚期子宫嵌顿一例[J]. 国际妇产科学杂志, 2024, 51(3): 350-353.

ZHANG Ya-nan, ZHAO Feng, JIANG Hong. A Case of Incarceration of the Gravid Uterus in Late Trimester of Pregnancy[J]. Journal of International Obstetrics and Gynecology, 2024, 51(3): 350-353.

图/表 2

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