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目的:子宫动脉瘤多被认为与产程中创伤性操作相关,但近年陆续有报道显示子宫动脉瘤可发生于自然分娩过程中。本文将为自然分娩过程中子宫动脉瘤的发生和紧急处理等提供参考指导。创新点:产前出血可能是子宫动脉瘤发生的潜在危险信号。方法:病例报道和文献汇纳分析。患者女,37岁,疤痕子宫,临产入院,产前出血,经阴顺产后12 h,突发阴道大量出血,常规对症处理(按摩子宫、阴道填塞、缩宫素静滴和欣母佩宫颈注射等)未能有效缓解,40 min内出血达1800 ml。床边B超未提示动脉瘤特征,数字减影血管造影(DSA)显示左侧子宫动脉瘤,即刻予动脉栓塞成功止血。患者产后4 d无并发症出院,随访无后遗症。结论:临床医师需要加强对子宫动脉瘤发生的警惕认识和急救处理水平。子宫动脉瘤和产程中的有创性操作无必然相关性,疤痕子宫的产前出血可能是子宫动脉瘤发生的潜在危险信号,产后随访应提高对晚期出血发生的警惕性。鉴于B超在诊断动脉瘤方面的有限性,高度怀疑动脉瘤时应尽快行血管造影明确诊断,及时栓塞处理。
Objective: Uterine aneurysms and more are considered to be associated with traumatic labor, but in recent years one after another has been reported that uterine aneurysms can occur in the course of natural childbirth. This article will provide a reference guide for the occurrence and emergency treatment of uterine aneurysms during spontaneous labor. Innovative point: Prenatal bleeding may be a potential risk of uterine aneurysm signal. Methods: Case reports and literature analysis. Female, 37 years old, scar uterus, admitted to hospital, prenatal bleeding, vaginal bleeding 12h, massive vaginal bleeding, routine symptomatic treatment (massage the uterus, vaginal tamponade, oxytocin intravenous injection and Xin mother’s injection Etc.) failed to effectively alleviate bleeding within 40 min up to 1800 ml. B-bedside aneurysm characteristics are not prompted, digital subtraction angiography (DSA) shows the left uterine aneurysm, immediately to the success of arterial embolization to stop bleeding. Patients without complications were discharged 4 days postpartum, no sequelae were followed up. CONCLUSION: Clinicians need to be more vigilant and emergency-care about the occurrence of uterine aneurysm. Uterine aneurysm has no necessary correlation with the invasive procedure in the labor process. Prenatal bleeding in the uterine scar may be a potential danger signal for uterine aneurysm. Postpartum follow-up should raise the vigilance of late bleeding. In view of the limitations of B-ultrasound in the diagnosis of aneurysms, a high degree of suspicion of aneurysm angiography should be as soon as possible a clear diagnosis, timely embolic treatment.