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中华产科急救电子杂志 ›› 2026, Vol. 15 ›› Issue (01) : 16 -20. doi: 10.3877/cma.j.issn.2095-3259.2026.01.005

妊娠合并子宫肌瘤

妊娠期子宫肌瘤红色变性的诊疗策略
赖慧娜, 罗艳敏()   
  1. 510080 广州,中山大学附属第一医院产科
  • 收稿日期:2025-11-11 出版日期:2026-02-18
  • 通信作者: 罗艳敏

Diagnosis and management strategies for red degeneration of uterine fibroids during pregnancy

Huina Lai, Yanmin Luo()   

  • Received:2025-11-11 Published:2026-02-18
  • Corresponding author: Yanmin Luo
引用本文:

赖慧娜, 罗艳敏. 妊娠期子宫肌瘤红色变性的诊疗策略[J/OL]. 中华产科急救电子杂志, 2026, 15(01): 16-20.

Huina Lai, Yanmin Luo. Diagnosis and management strategies for red degeneration of uterine fibroids during pregnancy[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2026, 15(01): 16-20.

妊娠期子宫肌瘤红色变性是妊娠中晚期特有的急症,严重时可导致多种母儿不良妊娠结局的发生。其多以急性腹痛和发热为主要表现,由于症状不典型,需与多种急腹症鉴别。临床工作中需充分评估子宫肌瘤变性情况,根据孕周、肌瘤特征(如大小、数量、部位)、临床症状及孕妇全身状况进行动态评估与分层处理,以保守治疗为主;若保守治疗无效,可考虑行子宫肌瘤剔除术。分娩前应该充分评估阴道试产的可行性,子宫肌瘤并非绝对的剖宫产指征;对于有阴道试产条件者产程中应严密观察,必要时及时干预,以减少母儿不良结局的发生。

Red degeneration of uterine leiomyomas during pregnancy is a distinct emergency occurring in the second and third trimesters, which may lead to various adverse maternal and fetal outcomes in severe cases. It is primarily characterized by acute abdominal pain and fever. Due to its atypical presentation, differentiation from various acute abdominal conditions is required. A comprehensive evaluation of the red degeneration is essential, involving dynamic assessment and stratified management based on gestational age, fibroid characteristics (e.g., size, number, location), clinical symptoms, and the patient′s overall condition. Conservative treatment should be the first-line approach. If conservative treatment proves ineffective, myomectomy may be considered. The feasibility of vaginal delivery should be thoroughly assessed, as uterine leiomyomas are not an absolute indication for cesarean section. For patients eligible for vaginal delivery, close monitoring during labor is necessary, with timely intervention when indicated to reduce adverse maternal and neonatal outcomes.

表1 妊娠期子宫肌瘤红色变性与常见鉴别疾病的鉴别要点
鉴别疾病 相同表现 鉴别要点
急性阑尾炎[15] 急性腹痛、发热、白细胞升高 1.急性阑尾炎为典型的转移性右下腹痛,孕早期疼痛位置与非孕期相同(麦氏点);孕中期位置逐渐上移,可达脐水平或略高于脐的右下腹;孕晚期位于右上腹、右侧腹,甚至右肋缘下
2.急性阑尾炎全身感染中毒症状(如高热、核左移)相对较重
3.超声检查:可见肿大阑尾或脓肿
卵巢囊肿蒂扭转[16] 突发性下腹剧痛,可伴恶心、呕吐 1.蒂扭转患者常有已知卵巢囊肿病史
2.蒂扭转的疼痛常与体位突然改变相关,且疼痛和压痛位置通常偏向一侧附件区,而非子宫体部
3.超声检查可见附件区囊性或混合性包块,特征性表现是蒂部血流信号消失
胎盘早剥[17] 剧烈腹痛、子宫压痛 1.胎盘早剥的腹痛常为持续性、进行性加剧,子宫硬如板状、张力高,宫缩间歇期也不缓解,常伴有阴道流血(可能为隐性出血)和胎心率异常
2.胎盘早剥,超声检查可见胎盘后血肿
3.胎心监护可见微小变异、延长减速或宫缩波异常
子宫破裂[18] 剧烈腹痛 1.子宫破裂绝大多数有明确的高危因素,如瘢痕子宫(剖宫产史、肌瘤剔除史),多发生在妊娠晚期或分娩期
2.典型表现为病理性缩复环、突发撕裂样剧痛、胎心率骤变或消失,产妇可能出现失血性休克
先兆早产/临产宫缩[19] 剧烈腹痛 1.先兆早产/临产的腹痛为规律性、阵发性宫缩,伴有宫颈管进行性缩短和宫口扩张
[1]
Pandit U, Singh M, Ranjan R. Assessment of maternal and fetal outcomes in pregnancy complicated by fibroid uterus[J]. Cureus202214(2):e22052.
[2]
Murata T, Kyozuka H, Endo Y, et al. Preterm deliveries in women with uterine myomas: the Japan environment and children′s study[J]. Int J Environ Res Public Health202118(5):2246.
[3]
冯玲,周璇. 妊娠期子宫肌瘤变性的处置[J]. 中国实用妇科与产科杂志202339(4):415-418.
[4]
子宫肌瘤的诊治中国专家共识专家组.子宫肌瘤的诊治中国专家共识[J].中华妇产科杂志201752(12):793-800.
[5]
Foti PV, Tonolini M, Costanzo V, et al. Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part II: uterine emergencies and pelvic inflammatory disease[J]. Insights Imaging201910(1):118.
[6]
Don EE, Vissers G, Landman AJEMC, et al. Preterm birth and uterine fibroid necrosis: the clinical presentation illustrated in a case series[J]. Eur J Obstet Gynecol Reprod Biol2024299:156-162.
[7]
Abdullah RK, Massey IY, Liu N, et al. The differences in characteristics of uterine leiomyomas and the diverse adverse pregnancy outcomes[J]. J Obstet Gynaecol202141(6):841-847.
[8]
Diana R, Nikhil P, Ivonne D, et al. Fibroids and pregnancy[J]. Int J Gynaecol Obstet2026172(1):51-58.
[9]
李丹,何志晖. 严重产后出血及与其相关的子宫切除危险因素分析[J/OL]. 中华产科急救电子杂志202110(4):220-224.
[10]
Coutinho Larissa M, Assis Wiviane A, Ananda S, et al. Uterine fibroids and pregnancy: how do they affect each other?[J]. Reprod Sci202229(8):2145-2151.
[11]
Milazzo GN, Catalano A, Badia V, et al. Myoma and myomectomy: poor evidence concern in pregnancy[J]. J Obstet Gynaecol Res201743(12):1789-1804.
[12]
Carpini GD, Morini S, Papiccio M, et al. The association between childbirth, breastfeeding, and uterine fibroids: an observational study[J]. Sci Rep20199(1):10117.
[13]
周梦玲,薛志伟,周淑. 妊娠合并子宫肌瘤的孕期变化及其与不良妊娠结局的关系[J/OL]. 中华妇幼临床医学杂志(电子版)202319(5):611-615.
[14]
杨楠楠,刘佳宁.不同途径超声检查在不同类型子宫肌瘤诊断中的应用[J].中国超声医学杂志202238(9):1048-1050.
[15]
肖露,黄莉萍. 妊娠期急性阑尾炎[J/OL]. 中华产科急救电子杂志202413(3):135-140.
[16]
Durai V, Kanikaram P, Thyagarajan C, et al. Acute abdomen during pregnancy with fibroid uterus: red degeneration or torsion?[J]. J Clin Diagn Res202216:QD01-03.
[17]
兰月,陈俊雅.胎盘早剥的超声表现及临床诊断价值分析[J].中国临床医学影像杂志202334(12):883-886.
[18]
Karlsen K, Kesmodel US, Mogensen O, et al. Relationship between a uterine fibroid diagnosis and the risk of adverse obstetrical outcomes: a cohort study[J]. BMJ Open202010(2):e032104.
[19]
Coutinho C M, Sotiriadis A, Odibo A, et al. ISUOG Practice Guidelines: role of ultrasound in the prediction of spontaneous preterm birth[J]. Ultrasound Obstet Gynecol202260(3):435-456.
[20]
刘燕燕,冯玲. 妊娠期常见非产科急腹症的诊断与处理[J/OL]. 中华产科急救电子杂志202413(3):129-134.
[21]
Cerdeira AS, Tome M, Moore N, et al. Seeing red degeneration in uterine fibroids in pregnancy: proceed with caution[J]. Lancet2019394(10212):e37.
[22]
冯烨,杨慧霞. 妊娠合并子宫肌瘤的诊疗新进展[J]. 中华妇产科杂志202560(5):399-402.
[23]
Dinsa LH, Eticha AD, Terefe MT. Successful myomectomy during pregnancy for the indication of acute lower abdominal pain with red degenerative myoma or ovarian torsion? " Case report" [J]. SAGE Open Med Case Rep202412:2050313X241301605.
[24]
杨淑丽,段微.妊娠期子宫肌瘤红色变性的处理[J].中国临床医生杂志201644(6):3-5.
[25]
Cavaliere AF, Vidiri A, Alletti SG, et al. Surgical treatment of " large uterine masses" in pregnancy: a single-center experience[J]. Int J Environ Res Public Health202118(22):12139.
[26]
Zi D, Guan Z, Ding Y, et al. Critical steps to performing a successful single-site laparoscopic myomectomy for large pedunculated myoma during pregnancy[J]. J Minim Invasive Gynecol202229(7):818-819.
[27]
Allameh Z, Allameh T. Successful myomectomy in the second trimester of pregnancy[J]. Adv Biomed Res20198(1):60.
[28]
Ouakka F, Rahmouni J, Saoud K, et al. Myomas and pregnancy: a case report and review of the literature case report[J]. Int Clin Pathol J202310(1):15-18.
[29]
Handa N, Anjali. Feto maternal outcomes of fibroid in pregnancy: a retrospective observational study[J]. Int J Reprod Contracept Obstet Gynecol202312(10):3080-3085.
[30]
Jose NA, Diana R, Miguel PJ, et al. Complex cesarean section: surgical approach to reduce the risks of intraoperative complications and postpartum hemorrhage[J]. Int J Gynaecol Obstet2025168(3):987-998.
[31]
路畅,胡江涛,王晓丹,等. 妊娠合并子宫肌瘤产科特征及妊娠结局临床分析[J]. 中国临床医生杂志202250(10):1221-1225.
[32]
González VG, Moreta AH, Triana AM, et al. Prolapsed cervical myoma during pregnancy[J]. Eur J Obstet Gynecol Reprod Biol2020252:150-154.
[33]
Zhao R, Wang X, Zou L, et al. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: a multicenter survey involving 112,403 deliveries[J]. PLoS One201712(11):e0187821.
[34]
Gundabattula SR, Bayyarapu VB, Pochiraju M, et al. Caesarean myomectomy of a large cervical fibroid[J]. Arch Gynecol Obstet2020301(3):859-861.
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