Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy
Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy
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DOI：
10.1016/j.ajog.2007.04.030
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发表时间：
2007-11-01
影响因子：
9.8
通讯作者：
Goldenberg, M.
中科院分区：
文献类型：
--
作者：
Katorza, E.;Soriano, D.;Goldenberg, M.
目的：子宫内膜异位症是已知的与早期妊娠并发症的风险增加，包括异位妊娠和流产。然而，迄今为止很少有报道与严重的子宫内膜异位症发生在妊娠晚期的并发症。研究设计：800名妇女参加了2002年至2006年期间的希巴医疗中心子宫内膜异位症诊所进行了回顾性分析。严重的子宫内膜异位症和相关并发症的情况下，在妊娠晚期identified.Results：三名妇女被发现谁经历了显着的腹腔内出血在妊娠晚期归因于病变导致严重的子宫内膜异位症。腹腔内出血发生在妊娠26-29周之间。所有病例的主要产前症状均为严重的下腹部疼痛。给予宫缩抑制剂或轻度镇痛剂后疼痛未缓解。在所有3例病例中进行的探查性剖腹手术显示存在显著的腹腔内出血，需要立即输注源于肿瘤病变的血液制品。结论：子宫内膜异位症的症状在妊娠期常可得到缓解。然而，严重的子宫内膜异位症引起的病变可导致妊娠晚期腹腔内出血。医生必须意识到，在这种情况下，可能需要进行密切的产前随访和及时干预。
Objective: Endometriosis is known to be associated with an increased risk for early pregnancy complications, including ectopic pregnancy and miscarriage. However, little has so far been reported on complications linked to severe endometriosis occurring during the third trimester of pregnancy.Study design: A retrospective review of 800 women attending the endometriosis clinic of the Sheba Medical Center during the years 2002-2006 was performed. Cases with severe endometriosis and associated complications during late pregnancy were identified.Results: Three women were found who experienced significant intra-abdominal bleeding in the third trimester of pregnancy attributed to a lesion resulting from severe endometriosis. The intraabdominal bleeding occurred between 26-29 weeks of gestation. In all cases the major presenting prenatal symptom was severe lower abdominal pain. The pain was not relieved by the administration of tocolytics or mild analgesics. Explorative laparotomy, performed in all 3 cases, revealed the presence of significant intraabdominal bleeding requiring immediate transfusion of blood products stemming from endometriotic lesions. Fetal complications occurred in all 3 cases.Conclusion: The symptoms of endometriosis are often relieved during pregnancy. Yet lesions caused by severe endometriosis can lead to significant intraabdominal bleeding during the third trimester of the pregnancy. Physicians must be aware that close antenatal follow-up and prompt intervention may be required in such cases.