- 期刊
Uterine Rupture Associated With Misoprostol Use in an Unscarred Uterus: A Case Report
服用Misoprostol引起的非疤痕後子宮破裂－罕見病例報告
摘要
目的：有文獻報告利用misoprostol引產而造成子宮破裂的案例，大部份發生於手術後的子宮。我們在此呈現一例使用misoprostol（100μg）引產後所造成非手術後子宮破裂的罕見案例。 病例報告：一位32歲，妊娠39週（G3P1A1）的婦女因落紅而至本院引產，產程一切正常，住院時的Bishop score為0分，因而使用100μg misoprostol 陰道塞劑來引產，在引產過程中，胎兒情況良好，在引產5小時後，就進入產房準備生產，後因fetal distress安排緊急剖腹生產，產下一男嬰，3710g，3→4但在術中發現子宮的右側壁有破裂的情形，而緊急以Vicryl 1°縫合子宮，很幸運地在縫合後很快的控制住子宮的出血。 結論：到目前為止使用misoprostol引產，並沒有標準劑量（使用範圍25-600μg），但醫師時時提高警覺，在使用高劑量misoprostol引產時，會有子宮破裂的危險，甚至非手術後的子宮也是一樣。
並列摘要
Objective: Uterine rupture associated with intravaginally administered misoprostol has been extensively reported in the medical literature. Most cases occur in patients with a scarred uterus or previous uterine surgery; however, there have only been a handful of reports on rupture in an unscarred uterus. Case Report(s): In this report, we present a case of uterine rupture in a 32-year-old multiparous woman after the trial of labor during which 100μg misoprostol was placed in the posterior vagina fornix. To our knowledge, there have been very few reports in the literature describing misoprostol at a high dosage such as ours for the purpose of labor induction, which probably ultimately contributes to uterine rupture as in our patient. An emergent cesarean section was performed due to fetal distress, and fortunately both mother and fetus recovered well with no complications. Conclusion(s): As depicted in this report, there is growing concern about the association of misoprostol with uterine rupture. The standard dosage of intravaginal misoprostol has not been determined, but there is speculation that an initial high dose of misoprostol should be avoided in favor of a low dose. The risk of uterine rupture is well documented in the literature, and physicians should exercise extreme caution when using misoprostol for cervical ripening at higher doses, even in an unscarred uterus.
延伸閱讀
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