妊娠期自发性腹腔内出血一例并文献复习

Spontaneous Hemoperitoneum in Pregnancy:A Case Report and Literature Review

妊娠期自发性腹腔内出血(spontaneous hemoperitoneum in pregnancy,SHiP)是一种严重的妊娠并发症,临床罕见且表现缺乏特异性,与子宫内膜异位症密切相关,会增加母胎不良结局的发生率。报告1例SHiP患者经手术救治,母胎平安的病例。该患者30岁,初产妇,既往有子宫内膜异位症病史,本次妊娠前4个月因双侧卵巢子宫内膜异位囊肿破裂行腹腔镜手术。于妊娠39+2周因持续下腹疼痛半小时入院,考虑有胎儿窘迫、胎盘早剥可能,行紧急剖宫产,术中见腹腔内出血1200 mL,娩出一女婴,1 min Apgar评分10分,胎盘未见早剥征象。盆腔探查见子宫右后壁中下段一新生静脉血管自发性破裂,伴活动性出血,局部予缝合止血。因此,临床上对于SHiP应及时发现、快速诊断,选择合适的干预措施,有助于改善母胎妊娠结局。

Spontaneous hemoperitoneum in pregnancy(SHiP)is a very rare and serious complication of pregnancy.Closely associated with endometriosis,and lack of specificity in clinic,it will increase the morbidity of the fetus and the mother.A SHiP case was reported that both mother and fetus were safe after operation.A 30-year-old primigravida was hospitalized with persistent lower abdominal pain lasting for half an hour at 39+2 weeks.She suffered from endometriosis and received laparoscopic surgery for rupture of ovarian endometrioma four months prior to the current pregnancy.An emergency cesarean section due to suspected fetal distress and possible placental abruption was performed and a healthy female neonatal was delivered with Apgar score of 10 at 1 min,and no placental signs of abruption.During the operation,1200 mL of intraperitoneal hemorrhage was seen.A new active bleeding venous vessel was seen in the middle and lower segment of the right posterior wall of the uterus.The bleeding was treated and healed by suturing.SHiP requires early detection,rapid diagnosis and appropriate intervention to improve maternal and fetal outcomes in clinical practice.