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CLC number: R737.33

On-line Access: 2017-08-08

Received: 2017-06-07

Revision Accepted: 2017-06-30

Crosschecked: 2017-07-19

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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.725-726

http://doi.org/10.1631/jzus.B17r0241


Authors’ response to the comment on “Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm”


Author(s):  Ning Zhang, Wen Di

Affiliation(s):  Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China

Corresponding email(s):   ningning1723@126.com, diwen163@163.com

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


Ning Zhang, Wen Di. Authors’ response to the 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): 725-726.

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Abstract: 
Thanks for the good comment by Matsubara et al. (2017) on our case of “antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm” (Zhang et al., 2017), published in the Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology). In the comment, the authors clarified two possibilities of our scenario: the uterine artery pseudoaneurysm (UAP) could be newly formed in the present delivery as a result of vulnerability of uterine artery and/or its branches at the site of previous cesarean section (CS) scar to exogeneous stimuli during labor contractions; the other possibility is that previous CS caused UAP formation but remained unruptured, and UAP continued to be intrauterine, a hyper-dynamic state during labor causing UAP-sac rupture and resultant antepartum hemorrhage, as well as postpartum hemorrhage.

作者对"疤痕子宫产前出血可能是子宫动脉瘤的潜在危险信号"的评论的回应

概要:在S. Matsubara等人对我们在《浙江大学学报(英文版)B辑:生物医学与生物技术》发表的一篇报道"疤痕子宫产前出血可能是子宫动脉瘤的潜在危险信号"(Zhang et al., 2017)的评论(Matsubara et al., 2017)中,对于子宫动脉瘤形成的机制给予了两种解释,进而结合其所在中心的研究数据和文献报道,提出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。这个结论对子宫动脉瘤的预防和诊疗等具有非常重要的指导价值。笔者查阅相关领域的文献,发现绝大多数研究者把创伤性操作的定义默认为当前妊娠分娩中所发生的操作,这样的定义容易让读者忽视既往创伤性操作史与子宫动脉瘤形成间的相关性。因此,笔者建议,在患者病例信息中,应该明确既往创伤性操作史的背景介绍,便于提高临床对子宫动脉瘤发生的警惕性,并有利于对子宫动脉瘤发生机制的研究。另外,临床工作者需要对疤痕子宫的产前出血特别重视,其可能是子宫动脉瘤发生破裂的潜在危险信号。
关键词:子宫动脉瘤;创伤性操作史;明确概念

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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]Cornette, J., van der Wilk, E., Janssen, N.M., et al., 2014. Uterine artery pseudoaneurysm requiring embolization during pregnancy. Obstet. Gynecol., 123(2 Pt 2):453-456.

[3]Matsubara, S., Takahashi, H., Matsubara, D., et al., 2017. Delivery or previous cesarean? A comment on “Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm”. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 18(8):723-724.

[4]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.

[5]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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