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中华产科急救电子杂志 ›› 2024, Vol. 13 ›› Issue (02) : 121 -123. doi: 10.3877/cma.j.issn.2095-3259.2024.02.012

病例报告

妊娠中期宫颈口扩张行羊膜腔穿刺减压术+宫颈环扎术延长至孕35+2周分娩一例
朱梦兰1, 陈慧1, 祝丽琼1, 刘颖琳1, 谭剑平1,()   
  1. 1. 510120 广州,中山大学孙逸仙纪念医院妇产科 广东省妇产疾病临床医学研究中心
  • 收稿日期:2023-09-29 出版日期:2024-05-18
  • 通信作者: 谭剑平
  • 基金资助:
    国家重点研发计划(2019YFA0801403); 北京健康促进会2022年生殖医学中青年医生研究-临床研究项目(BJHPA-2022-SHZHYXZHQNYJ-LCH-011); 广东省自然科学基金(2023A1515010515)

A case of delivery after amniotic cavity puncture and decompression combined with cervical cerclage extended to 35+2 weeks of pregnancy after cervical dilatation in the second trimester of pregnancy

Menglan Zhu, Hui Chen, Liqiong Zhu   

  • Received:2023-09-29 Published:2024-05-18
引用本文:

朱梦兰, 陈慧, 祝丽琼, 刘颖琳, 谭剑平. 妊娠中期宫颈口扩张行羊膜腔穿刺减压术+宫颈环扎术延长至孕35+2周分娩一例[J]. 中华产科急救电子杂志, 2024, 13(02): 121-123.

Menglan Zhu, Hui Chen, Liqiong Zhu. A case of delivery after amniotic cavity puncture and decompression combined with cervical cerclage extended to 35+2 weeks of pregnancy after cervical dilatation in the second trimester of pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(02): 121-123.

患者30岁,孕1产0,因"孕24+5周,下腹坠胀13 d,发现宫颈扩张10 d"于2023年7月6日13:00收入我院产科。患者平素月经不规则,末次月经2022年11月12日,根据早孕期超声纠正预产期为2023年10月21日。孕期无特殊药物服用史,否认放射线和特殊化学物品接触史,无猫狗接触史。孕期外院产检,查血常规、尿常规、甲状腺功能、乙肝、丙肝、地中海贫血、梅毒二项、艾滋病、早期及中期唐氏筛查、颈项透明层厚度及胎儿产前Ⅱ级超声均未见明显异常。2023年6月23日,患者无明显诱因出现不规则下腹坠胀感,进行性加重。6月26日出现阴道少许血性分泌物,无伴阴道流液,遂于当地医院就诊,行阴道窥诊示"宫颈外口扩张3 cm,可见羊膜囊突出于宫颈外口",遂住院行安胎治疗,因患者有不规则宫缩,予硫酸镁联合阿托西班静脉滴注抑制宫缩治疗;6月27日因宫缩减少停用硫酸镁,阿托西班以12 ml/h维持静脉滴注;7月2日,患者出现咳嗽,伴发热,体温最高达38.7 ℃,无伴咳痰等不适,急抽血检查示"超敏C反应蛋白15.53 mg/L,降钙素原0.137 ng/ml",当地医院给予对症治疗,再次阴道窥诊见"宫颈外口扩张,羊膜囊突出约4 cm"。7月6日,患者转诊至我院治疗。既往史:否认慢性病及传染病病史,否认心脏病病史,否认疾病外伤史,否认输血史,否认过敏史。

图1 羊膜腔穿刺前后羊膜囊变化 A:入院窥诊羊膜囊凸出于宫颈外口;B:羊膜腔穿刺术后羊膜囊张力降低
图2 妊娠中期宫颈扩张患者紧急宫颈环扎术后宫颈闭合图
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