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CLC number: R737.33

On-line Access: 2017-08-08

Received: 2017-05-06

Revision Accepted: 2017-05-30

Crosschecked: 2017-07-19

Cited: 1

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Citations:  Bibtex RefMan EndNote GB/T7714

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Journal of Zhejiang University SCIENCE B 2017 Vol.18 No.8 P.723-724

http://doi.org/10.1631/jzus.B1700241


Delivery or previous cesarean? A comment on “Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm”


Author(s):  Shigeki Matsubara, Hironori Takahashi, Daisuke Matsubara, Yosuke Baba

Affiliation(s):  Department of Pediatrics, Jichi Medical University, 329-0498 Tochigi, Japan

Corresponding email(s):   matsushi@jichi.ac.jp

Key Words:  Antepartum hemorrhage, Delivery, Pseudoaneurysm, Uterine artery pseudoaneurysm, Postpartum hemorrhage


Shigeki Matsubara, Hironori Takahashi, Daisuke Matsubara, Yosuke Baba. Delivery or previous cesarean? A comment on “Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm”[J]. Journal of Zhejiang University Science B, 2017, 18(8): 723-724.

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Abstract: 
Uterine artery pseudoaneurysm (UAP), an important disorder causing postpartum hemorrhage, has been considered to occur after “traumatic delivery” such as cesarean section (CS). Our recent study (Baba et al., 2016) confirmed that UAP can also occur after “non-traumatic” delivery.

与妊娠相关的子宫动脉瘤形成是源于此次分娩还是前次瘢痕子宫?--对一篇病例报道"疤痕子宫产前出血可能是子宫动脉瘤的潜在危险信号"的评论

概要:子宫动脉瘤多被认为与产程中创伤性操作相关,但也可发生于无创伤性操作的自然分娩过程中。最近狄文和张宁等人在《浙江大学学报(英文版)B辑:生物医学与生物技术》中报道了一例临床病例(Zhang et al., 2017):疤痕子宫妊娠→子宫收缩→产前出血→阴道分娩急产→严重产后出血→子宫动脉栓塞。该病例中的子宫动脉瘤形成的原因可能是:(1)此次分娩过程中,子宫疤痕处的血管分支薄弱,宫缩压力诱发子宫动脉瘤形成并破裂;(2)前次剖宫产术的创伤性操作导致子宫动脉瘤形成但并未破裂,此次妊娠分娩促进动脉瘤的破裂出血。我们汇总分析了50例子宫动脉瘤患者,29例都是前次妊娠(最近第2次妊娠)有创伤性操作,而在另外21例中,其中9例在最近第3次妊娠中都存在创伤性操作。这些提示子宫动脉瘤的形成可能与所有既往的创伤性操作史有关,两者间的时间间隔可能很长,比如10年甚至20年之久。此外,张宁等人的病例报道也提示子宫动脉瘤不仅仅表现为产后出血,产前出血也可能是其危险信号。
关键词:子宫动脉瘤;创伤性操作史;产后出血;产前出血

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Reference

[1]Baba, Y., Takahashi, H., Ohkuchi, A., et al., 2016. Uterine artery pseudoaneurysm: its occurrence after non-traumatic events, and possibility of “without embolization” strategy. Eur. J. Obstet. Gynecol. Reprod. Biol., 205:72-78.

[2]Johannesson, L., Mason, J., Oehler, M.K., 2017. Uterine artery pseudoaneurysm bleeding one decade after caesarean section: a case report. J. Obstet. Gynaecol. Res., 43(5):939-942.

[3]Papadakos, N., Wales, L., Hayes, K., et al., 2008. Post-traumatic pelvic pseudoaneurysm and arterio-venous fistula: combined endovascular and surgical approach. Eur. J. Vasc. Endovasc. Surg., 36(2):164-166.

[4]Zhang, N., Lou, W.H., Zhang, X.B., et al., 2017. Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 18(5):441-444.

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