妊娠期子宫及宫旁静脉破裂出血6例诊治分析

The diagnosis and treatment for rupture and bleeding of uterine and parauterine vein during pregnancy:analysis of six cases

目的探讨妊娠期子宫及宫旁静脉破裂出血的诊断,治疗及孕妇、胎儿预后。方法回顾性分析台州市中心医院2001年1月至2012年8月收治的6例子宫及宫旁静脉破裂出血的诊治过程。结果 6例孕妇均以无明显诱因的剧烈腹痛症状就诊,超声检查腹腔中均见游离液体,其中3例见血肿形成,腹腔穿刺均抽出不凝血,均行开腹探查,1例中孕单胎行缝扎和明胶海绵填塞止血,保守治疗至足月后剖宫分娩,胎儿存活,4例晚孕单胎立即行剖宫产,胎儿存活,1例中孕双胎行剖宫产,胎儿死亡。结论超声提示腹腔积液,腹穿抽出不凝血并排除其他可能病因,术前可以做出子宫及宫旁静脉破裂出血的诊断,及时治疗能提高围产儿生存率。

Objective To discuss the diagnosis and treatment for rupture and bleeding of uterine and parauterine vein during pregnancy and the prognosis of the pregnant women and fetus. Methods To retrospectively analyze the diagnosis and treatment course for the six cases of uterine and parauterine vein rupture and bleeding during pregnan- cy received between January, 2001 and August, 2012 in Taizhou Central Hospital. Results All of the six cases of pregnant women went to see a doctor for the acute abdominal pain symptoms with no obvious incentive, ultrasonogra- phy exam hinted the seroperitoneum, of which three cases were observed the hematoma ; non-coagulate bleed were drew by abdominocentesis and exploratory laparotomy were performed for the all cases; for one case who was mid- pregnancy with single fetus, seaming and hemostasis by tamping gelatin sponge was performed, and conservative ther- apy was conducted until the fetus was delivered for mature , the fetus by caesarean section is survived; four cases were late pregnancy with single fetus and were conducted caesarean section and the fetuses were all survived; the last case middle twin pregnancy was conducted caesarean section and the fetal death occurred. Conclusions Ultra- sonic examination suggested that seroperitoneum occurred, the other pathogenesis was excluded and the non-coagula- tion fluid drew with abdominocentesis, the uterine and parauterine vein bleeding during in the duration of pregnancy can be diagnosed before operation so as immediate treatment can be performed to enhance the survival rate of the perinatal infant.