@article{oai:hama-med.repo.nii.ac.jp:00003555,
 author = {戎野, 志織 and 水野, 薫子 and 南波, 美沙 and 米澤, 真澄},
 issue = {1},
 journal = {静岡産科婦人科学会雑誌},
 month = {Mar},
 note = {症例は35歳、初妊婦。他院で腹腔鏡下子宮筋腫核出術を受け、術後5か月で顕微授精により妊娠した。妊娠34週4日に帰省分娩希望のため当院を受診し、特に異常は認めなかった。妊娠34週5日に持続的な下腹部痛のため受診。胎児心拍陣痛図ではreassuring fetal statusで、2分毎の規則的な子宮収縮を認めた。血液検査、経腹超音波では異常を認めず、頸管長は29mmと短縮していた。切迫早産の診断で入院し、リトドリン塩酸塩の点滴を開始した。子宮収縮のないときにも腹痛はあり、体位により痛みは変動した。妊娠34週6日に硫酸マグネシウムの点滴を併用し、妊娠35週1日には腹痛は消失した。その後症状の増悪はなく、妊娠継続した。子宮筋腫核出後妊娠の適応で妊娠37週6日に選択的帝王切開を施行。児娩出後に右卵管角付近で内腔に達する約2cmの裂創を認め、子宮破裂と診断した。裂創から前壁にかけて筋腫核出創部に沿って数か所筋層が欠損し、漿膜のみで保たれている状態であった。筋層断裂部位を切除し、筋層を縫合し修復した。術後経過は良好で、術後8日目に退院した。子宮筋腫核出後の子宮破裂は稀だが、母児ともに重篤な結果となる可能性の高い合併症であり、筋腫核出後の妊娠では子宮破裂を念頭におく必要があると再認識した。, A 35-year-old primigravid woman underwent laparoscopic myomectomy, and conceived using intracytoplasmic sperm injection five months after surgery.
She was referred to our hospital at 34 weeks and 4 days as she desired to give birth near her home. She had no abnormal findings. She visited our hospital at 34 weeks and 5 days due to persistent lower abdominal pain. Cardiotocographic monitoring revealed a reassuring fetal status and regular uterine contraction every two minutes. There were no abnormal findings on blood test and abdominal ultrasound, but the cervical length was short, only 29mm.
We diagnosed premature labor, admitted her to hospital, and started ritodrine hydrochloride.
Abdominal pain persisted even with no uterine contractions, and the pain changed depending on position. We started magnesium sulfate at 34 weeks and 6 days. At 35 weeks and 1 day, abdominal pain disappeared.
There was no exacerbation of symptoms, so she managed to continue the pregnancy. C-section was performed at 37 weeks and 6 days for adaptation after myomectomy.
After the delivery, a wound of approx. 2cm was found to have reached into the cavity near the corner of the right Fallopian tube. We diagnosed uterine rupture. There was loss of myometrium in several locations from the wound to the anterior wall along the previous myomectomy scar, and only the perimetrium was maintained. We performed debridement of the lesion, and sutured the layers to repair it. Her post-operative condition was good, and she was discharged on the 8th day after surgery.
Uterine rupture after myomectomy is rare, but there is a high possibility of serious complications for the mother and child.
This case underlined the fact that it is necessary to keep the possibility of uterine rupture in mind in the event of pregnancy after myomectomy.},
 pages = {30--36},
 title = {腹腔鏡下子宮筋腫核出術後の子宮破裂の1例},
 volume = {9},
 year = {2020}
}