妊娠第3三半期に妊娠子宮嵌頓症を診断した場合に分娩時の重篤な合併症を回避するには：4例の比較
妊娠子宮嵌頓症は，過度に後屈した妊娠子宮が増大して骨盤腔に嵌頓した状態であり，重篤な合併症をきたしうる．無症候性の妊娠子宮嵌頓症を第3三半期に診断し，合併症なく帝王切開を行った4症例を経験した．3例はダグラス窩を占拠する筋腫を認め，1例はダグラス窩の癒着によるものであった．いずれの症例でも，腟鏡診では子宮腟部が腹側へ極端に偏移し，MRI所見で子宮の後屈所見と内子宮口の頭側への移動および子宮頸部の過伸展を認めたことから本症を疑った．全例，帝王切開時に術中超音波検査を行い，子宮筋層切開部を決定した．このように，身体所見から本症を疑い，画像診断をもとに術式を選択したことで帝王切開時の合併症の回避につ...
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| Published in | 日本周産期・新生児医学会雑誌 Vol. 58; no. 2; pp. 334 - 340 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本周産期・新生児医学会
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1348-964X 2435-4996 |
| DOI | 10.34456/jjspnm.58.2_334 |
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| Abstract | 妊娠子宮嵌頓症は，過度に後屈した妊娠子宮が増大して骨盤腔に嵌頓した状態であり，重篤な合併症をきたしうる．無症候性の妊娠子宮嵌頓症を第3三半期に診断し，合併症なく帝王切開を行った4症例を経験した．3例はダグラス窩を占拠する筋腫を認め，1例はダグラス窩の癒着によるものであった．いずれの症例でも，腟鏡診では子宮腟部が腹側へ極端に偏移し，MRI所見で子宮の後屈所見と内子宮口の頭側への移動および子宮頸部の過伸展を認めたことから本症を疑った．全例，帝王切開時に術中超音波検査を行い，子宮筋層切開部を決定した．このように，身体所見から本症を疑い，画像診断をもとに術式を選択したことで帝王切開時の合併症の回避につながった． |
|---|---|
| AbstractList | 妊娠子宮嵌頓症は，過度に後屈した妊娠子宮が増大して骨盤腔に嵌頓した状態であり，重篤な合併症をきたしうる．無症候性の妊娠子宮嵌頓症を第3三半期に診断し，合併症なく帝王切開を行った4症例を経験した．3例はダグラス窩を占拠する筋腫を認め，1例はダグラス窩の癒着によるものであった．いずれの症例でも，腟鏡診では子宮腟部が腹側へ極端に偏移し，MRI所見で子宮の後屈所見と内子宮口の頭側への移動および子宮頸部の過伸展を認めたことから本症を疑った．全例，帝王切開時に術中超音波検査を行い，子宮筋層切開部を決定した．このように，身体所見から本症を疑い，画像診断をもとに術式を選択したことで帝王切開時の合併症の回避につながった． |
| Author | 小林, 康祐 丸山, 陽介 清水, 陽彦 大藏, 慶憲 |
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| References | 2) O’Connell MP, Ivory CM, Hunter RW：Incarcerated retroverted uterus--a non recurring complication of pregnancy. Journal of obstetrics and gynaecology：the journal of the Institute of Obstetrics and Gynaecology 1999；19：84-5 5) Hamod H, Chamberlain PF, Moore NR, et al.：Conservative treatment of an incarcerated gravid uterus. BJOG：an international journal of obstetrics and gynaecology 2002；109：1074-5 4) Han C, Wang C, Han L, et al.：Incarceration of the gravid uterus：a case report and literature review. BMC pregnancy and childbirth 2019；19：408 11) Shima E, Serikawa T, Itsukaichi M, et al.：Pregnancy complicated by uterine sacculation due to a huge myoma. J Obstet Gynaecol Res 2012；38：1111-4 3) Jacobsson B, Wide-Swensson D：Incarceration of the retroverted gravid uterus--a review. Acta obstetricia et gynecologica Scandinavica 1999；78：665-8 13) Gardner CS, Jaffe TA, Hertzberg BS, et al.：The incarcerated uterus：a review of MRI and ultrasound imaging appearances. AJR American journal of roentgenology 2013；201：223-9 6) Hsu PC, Yu MH, Wang CY, et al.：Asymptomatic uterine incarceration at term：Successful management of a rare complication in pregnancy. Taiwanese journal of obstetrics & gynecology 2018；57：745-9 7) Singh MN, Payappagoudar J, Lo J, et al.：Incarcerated retroverted uterus in the third trimester complicated by postpartum pulmonary embolism. Obstetrics and gynecology 2007；109：498-501 8) Samejima K, Matsunaga S, Takai Y, et al.：Efficacy of well-planned management in patients with incarcerated gravid uteus：A case series and literature review. Taiwanese journal of obstetrics and gynecology 2021；60：679-684 15) Ouchi N, Kuwabara Y, Yonezawa M, et al.：Successful Management of Complicated Uterine Displacement Caused by Unilateral Incarceration of the Bicornuate Uterus. Case reports in obstetrics and gynecology 2019；2019：3205610 9) van der Tuuk K, Krenning RA, Krenning G, et al.：Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section：a case report. Journal of medical case reports 2009；3：103 1) Fadel HE, Misenhimer HR：Incarceration of the retroverted gravid uterus with sacculation. Obstetrics and gynecology 1974；43：46-9 10) Inaba F, Kawatu T, Masaoka K, et al.：Incarceration of the retroverted gravid uterus：the key to successful treatment. Archives of gynecology and obstetrics 2005；273：55-7 12) Hachisuga N, Hidaka N, Fujita Y, et al.：Significance of pelvic magnetic resonance imaging in preoperative diagnosis of incarcerated retroverted gravid uterus with a large anterior leiomyoma：a case report. The Journal of reproductive medicine 2012；57：77-80 14) Gottschalk EM, Siedentopf JP, Schoenborn I, et al.：Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation：case report and review of the literature. Ultrasound in obstetrics & gynecology：the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2008；32：582-6 |
| References_xml | – reference: 9) van der Tuuk K, Krenning RA, Krenning G, et al.：Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section：a case report. Journal of medical case reports 2009；3：103 – reference: 7) Singh MN, Payappagoudar J, Lo J, et al.：Incarcerated retroverted uterus in the third trimester complicated by postpartum pulmonary embolism. Obstetrics and gynecology 2007；109：498-501 – reference: 10) Inaba F, Kawatu T, Masaoka K, et al.：Incarceration of the retroverted gravid uterus：the key to successful treatment. Archives of gynecology and obstetrics 2005；273：55-7 – reference: 12) Hachisuga N, Hidaka N, Fujita Y, et al.：Significance of pelvic magnetic resonance imaging in preoperative diagnosis of incarcerated retroverted gravid uterus with a large anterior leiomyoma：a case report. The Journal of reproductive medicine 2012；57：77-80 – reference: 3) Jacobsson B, Wide-Swensson D：Incarceration of the retroverted gravid uterus--a review. Acta obstetricia et gynecologica Scandinavica 1999；78：665-8 – reference: 6) Hsu PC, Yu MH, Wang CY, et al.：Asymptomatic uterine incarceration at term：Successful management of a rare complication in pregnancy. Taiwanese journal of obstetrics & gynecology 2018；57：745-9 – reference: 11) Shima E, Serikawa T, Itsukaichi M, et al.：Pregnancy complicated by uterine sacculation due to a huge myoma. J Obstet Gynaecol Res 2012；38：1111-4 – reference: 2) O’Connell MP, Ivory CM, Hunter RW：Incarcerated retroverted uterus--a non recurring complication of pregnancy. Journal of obstetrics and gynaecology：the journal of the Institute of Obstetrics and Gynaecology 1999；19：84-5 – reference: 8) Samejima K, Matsunaga S, Takai Y, et al.：Efficacy of well-planned management in patients with incarcerated gravid uteus：A case series and literature review. Taiwanese journal of obstetrics and gynecology 2021；60：679-684 – reference: 5) Hamod H, Chamberlain PF, Moore NR, et al.：Conservative treatment of an incarcerated gravid uterus. BJOG：an international journal of obstetrics and gynaecology 2002；109：1074-5 – reference: 1) Fadel HE, Misenhimer HR：Incarceration of the retroverted gravid uterus with sacculation. Obstetrics and gynecology 1974；43：46-9 – reference: 13) Gardner CS, Jaffe TA, Hertzberg BS, et al.：The incarcerated uterus：a review of MRI and ultrasound imaging appearances. AJR American journal of roentgenology 2013；201：223-9 – reference: 4) Han C, Wang C, Han L, et al.：Incarceration of the gravid uterus：a case report and literature review. BMC pregnancy and childbirth 2019；19：408 – reference: 14) Gottschalk EM, Siedentopf JP, Schoenborn I, et al.：Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation：case report and review of the literature. Ultrasound in obstetrics & gynecology：the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2008；32：582-6 – reference: 15) Ouchi N, Kuwabara Y, Yonezawa M, et al.：Successful Management of Complicated Uterine Displacement Caused by Unilateral Incarceration of the Bicornuate Uterus. Case reports in obstetrics and gynecology 2019；2019：3205610 |
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| Title | 妊娠第3三半期に妊娠子宮嵌頓症を診断した場合に分娩時の重篤な合併症を回避するには：4例の比較 |
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