论文部分内容阅读
目的:探讨妊娠子宫嵌顿的诊断和治疗。方法:回顾性纳入2016年8月至2020年2月湖南省妇幼保健院收治的4例产前超声提示妊娠子宫嵌顿孕妇。分析其临床表现、诊断难点及处理要点。采用描述性统计分析。结果:4例孕妇主要症状均为阴道流血或流液，超声检查提示妊娠子宫嵌顿。2例未见阴道后穹隆膨出，1例有后穹隆膨出，1例因孕周小，门诊未进行专科检查。3例在孕晚期诊断，1例在孕14周诊断。结合孕妇孕周、子宫前壁肌层厚度的变化、自身的症状，并给予促胎肺成熟，3例孕妇行择期剖宫产术，皮肤切口取下腹正中直切口，子宫切口取高位横切口，术后新生儿状况良好，孕妇子宫复旧好，腹壁及子宫伤口愈合好；孕14周诊断者胸膝卧位治疗2周，超声提示子宫位置恢复正常，膀胱位置正常。结论:本病临床表现缺乏特异性，有相关症状体征时应联想到本病的可能，并注意与前置胎盘的鉴别诊断及2种情况共存可能。剖宫产时机需要结合多方面因素决定；切口宜选择下腹正中直切口及子宫高位横切口，后者往往需借助解剖标志定位。“,”Objective:To investigate the diagnosis and treatment for incarceration of retroverted uterus in pregnant women.Methods:This study retrospectively recruited four gravidas with incarcerated retroverted uterus indicated by prenatal ultrasonography in Hunan Provincial Maternal and Child Health Care Hospital from August 2016 to February 2020. Clinical features, diagnosis, and treatment of these cases were described.Results:Vaginal bleeding or discharge were the main symptoms of the four cases and prenatal ultrasound suggested incarcerated retroverted uterus. Obstetric examination was performed for all cases, except one due to small gestational age, and bulging posterior fornix was found in one case. Three cases were diagnosed in the third trimester and one at 14 gestational weeks. In light of gestations, symptoms, and anterior uterine muscle thickness, three patients underwent planned cesarean sections with a median abdominal incision and a superior transverse uterine incision after fetal lung maturation acceleration. Uterus involution was good, and the incisions healed well in these three cases, with all neonates in good condition. Following a two-week knee-chest position treatment, the position of her uterus and bladder turned normal in case 4.Conclusions:Considering the atypical clinical presentations, clinicians should be aware of incarceration of retroverted uterus when related symptoms or signs were presented. Placenta previa might be the comorbidity and should be differentially diagnosed. The timing of a cesarean section is supposed to be determined based on multiple factors. Moreover, a median abdominal incision and a superior transverse uterine incision are recommended, and an anatomic landmark is often required for the latter's accurate position.