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- Placenta Previa Accreta with Cervical Involvement Causing Tenacious Postpartum Hemorrhage: A Case Report
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題 名 | Placenta Previa Accreta with Cervical Involvement Causing Tenacious Postpartum Hemorrhage: A Case Report=合併子宮頸侵犯之植入性前置胎盤導致嚴重的產後出血:一病例報告 |
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作 者 | 王鵬惠; 趙湘臺; 袁九重; 林錦洲; 顏明賢; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:2 1998.02[民87.02] |
頁 次 | 頁116-120 |
分類號 | 417.453 |
關鍵詞 | 剖腹產後子宮切除; 植入性前置胎盤; 產後出血; Cesarean hysterectomy; Placenta previa accreta; Postpartum hemorrhage; |
語 文 | 英文(English) |
中文摘要 | 雖然偶發之嚴重產後出血可能導致母親死亡,但是對植入性胎盤採取保守治療近年來已經廣為接受。我們報告一例植入性前置胎盤合併子宮頸侵犯導致嚴重產後出血。一名二十八歲孕婦、胎次二產數一、有過一次剖腹生產、在妊娠三十八週時因完全前置胎盤併發植入性胎盤,排定接受再次剖腹生產。病人以剖腹生產方式,產下一名三千七百克之男嬰。胎盤徒手剝離有些困難,且有殘留的胎盤組織黏附在子宮壁上。子宮內注射子宮收縮劑、麥角鹼肌肉注射,子宮動脈結紮,以及子宮下段填塞等皆被用以控制出血,傷口在達到一定程度之止血後像往常般關合。但是正當縫閉腹壁時,發現有陰道出血。雖然經過保守治療,包括由陰道向子宮腔填塞紗卷、壓迫按摩子宮、輸血及靜脈注射前列腺素(sulprostone),病人仍然因持續陰道出血,逐漸出現休克症狀。經緊急剖腹探查後,發現在子宮頸部位有動脈出血,所以毫不猶豫地施行剖腹產後全子宮切除術。 植入性前置胎盤是一項嚴重且緊急之疾病,偶而會侵犯子宮頸且造成大量出血。任何有植入性前置胎盤的病人皆應小心地評估保留子宮之可能。一旦有合併侵犯子宮頸之植入性前置胎盤,子宮切除等積極治療應予採行,以期減少併發症及死亡。 |
英文摘要 | Conservative treatment for placenta accreta has recently been popularly accepted even though serious postpartum hemorrhage, resulting in maternal death, may occur. We report a case of placenta previa accreta with cervical involvement resulting in tenacious postpartum hemorrhage. A 28-year-old pregnant woman, gravida-2 para-1, who had undergone a previous cesarean section, was scheduled for a repeat cesarean section because of complete placenta previa associated with placenta accreta. The patient underwent cesarean section and delivered a 3,700g, male infant. Manual removal of the placenta was performed with some difficulty and redundant placental tissue remained adhered to the uterine wall. Oxytocin, ergometrine, uterine arterial ligation and packing of the lower uterine segment were used to control bleeding; the wound was closed as usual after achieving adequate hemostasis. While closing the abdominal wall, vaginal bleeding was noted. After conservative treatment, shock progressively emerged due to persistent vaginal bleeding. Emergency laparotomy found active bleeding from the cervix and total abdominal hysterectomy was performed without hesitation. Careful evaluation is mandatory to preserve the uterus. In the case of cervical involvement, aggressive treatment such as hysterectomy should be undertaken promptly to decrease the risks of both morbidity and mortality. |
本系統中英文摘要資訊取自各篇刊載內容。