市山 卓彦, 田中 利隆, 佐藤 杏奈, 植木 典和, 平山 貴士, 山口 貴史, 菅沼 牧知子, 田中 沙織, 五十嵐 優子, 田口 雄史, 三橋 直樹

Takuhiko ICHIYAMA, Toshitaka TANAKA, Anna SATO, Norikazu UEKI, Takashi HIRAYAMA, Takashi YAMAGUCHI, Machiko SUGANUMA, Saori TANAKA, Yuko IGARASHI, Takeshi TAGUCHI, Naoki MITSUHASHI

順天堂大学医学部附属静岡病院産婦人科

Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital

キーワード : unscarred uterine rupture, shock in the perinatal period

非瘢痕子宮に発症する子宮破裂は診断に難渋することが多い．今回非瘢痕子宮の妊婦が分娩後に原因不明のショックのため産褥搬送となり，超音波検査により子宮破裂と診断した2例を経験した．1例目は34歳の初産婦に対し妊娠41週1日に分娩誘発を行った．胎児機能不全のため子宮底圧迫法を併用した吸引分娩で3,370 g，Ap 9/10の女児を娩出したが，分娩2時間後ショックとなり搬送されてきた．来院時血圧106/66 mmHg，心拍数153/分，Shock Index（以下SI）1.5であった．経腹超音波上，子宮水平断で左側筋層の連続性の途絶を認め，子宮破裂と診断した．造影CT検査を行った後，開腹し破裂部分を縫合止血した．2症例目は40歳の3経妊1経産の妊婦に対し，妊娠40週5日に分娩誘発を行った．胎児機能不全のため子宮底圧迫法を併用した吸引分娩で2,670 g，Ap 2/2の女児を娩出したが，分娩20分後にショックとなり搬送されてきた．来院時血圧101/73 mmHg，心拍数123/分，SI 1.2であった．経腹超音波上，子宮水平断で右側筋層の連続性の途絶を認め，子宮破裂と診断した．造影CT検査を行った後，開腹したが子宮の温存は困難であったため，子宮全摘出術を行った．分娩後ショックとなった場合，非瘢痕子宮であっても子宮破裂を鑑別すべきであり，診断には超音波検査で子宮水平断の子宮筋層の連続性を確認することが簡便で有用である．

Unscarred uterine rupture is rare and often difficult to diagnose. We encountered two cases of women with unscarred uteruses who were brought to our hospital in the perinatal period in a state of shock due to unknown causes. We were able to rapidly diagnose them with transabdominal ultrasonography. Case 1: A 34-year-old gravida 0, para 0 woman underwent labor induction. She was 41 weeks and 1 day pregnant. She had no past history. She delivered by vacuum extraction. She was brought to our hospital because she fell into a state of shock two hours after delivery. When she arrived, her blood pressure was 106/66 mmHg, her heart rate was 153/min, and her shock index was 1.5. We performed transabdominal ultrasonography immediately. We diagnosed a uterine rupture because we noticed a disruption of the left side of the uterine muscle layer in the axial images. An emergency laparotomy was performed after contrast CT examination. We repaired the laceration of the uterus. Case 2: A 40-year-old 3 gravida, 1 para woman underwent labor induction. She was 40 weeks and 5 days pregnant. She had no past history. She delivered by vacuum extraction. She was brought to our hospital because she fell into a state of shock 20 minutes after delivery. When she arrived, her blood pressure was 101/73 mmHg, her heart rate was 123/min, and her shock index was 1.2. We performed transabdominal ultrasonography immediately. We diagnosed a uterine rupture after identifying a disruption of the right side of the uterine muscle layer in the axial images. An emergency laparotomy was performed after contrast CT examination. We performed a total hysterectomy because it was too difficult to repair. It is useful in the diagnosis of uterine rupture to look for disruptions of the uterine muscle layer when we perform ultrasonography.