妊娠 28 週に卵管角の胎盤付着部位から子宮破裂を起こした 1 症例

DOI: 10.3179/jjmu. JJMU.A.30
◇ CASE REPORT ◇ 妊娠 28 週に卵管角の胎盤付着部位から子宮破裂を起こした 1 症例
大場智洋
市塚清健
長谷川潤一
関沢明彦
新垣達也
仲村将光
松岡隆
抄　録
妊娠 28 週に卵管角部の子宮破裂を生じた 1 例を報告する．30 歳，0 回経妊，子宮手術の既往はない．妊娠 26 週 2
日，頻回な子宮収縮と性器出血を認め当科紹介になった．左側腹部に軟な腫瘤を触知した．経腹超音波検査で，腫
瘤は，子宮卵管角から突出しており，中には胎盤が折りたたまれたように存在した．胎盤と子宮筋層に echo free
space はなかった．左卵管角部の切迫子宮破裂を疑った．妊娠 27 週 3 日，超音波検査で胎盤辺縁に 39 × 24 mm 大，
網状の low echo area を認め，胎盤辺縁血腫と診断した．妊娠 28 週 1 日，子宮収縮が頻回となり，腫瘤に圧痛を認
め，超音波検査では胎盤辺縁の low echo area は 2 ヵ所あり 68 × 19 mm と 93 × 36 mm 大と拡大していた．胎児心
拍数陣痛図では，prolonged deceleration を認めた．子宮破裂，胎盤早期剥離を疑い，緊急帝王切開術を施行した．
術中出血量 1, 065 g，出生児体重 1, 173 g，Apgar score（1 / 5 分値）8 / 9 点，臍帯動脈血 pH 7. 231 であった．子宮
左卵管角は 6 × 7 cm に膨隆しており，子宮筋層は菲薄，断裂していた．卵管角の胎盤付着による子宮破裂と診断
した．卵管角部を楔状に切除し，子宮筋層を 3 層縫合した．既往歴や妊娠の経過から子宮破裂の危険性が低い症例
であっても，胎盤位置の異常によっては，子宮破裂に至ることもあり，その危険性を念頭に置くことが重要である．
A case of uterine rupture in a case with a corneal placenta
Tomohiro OBA, Junichi HASEGAWA, SJUSM, Tatsuya ARAKAKI, FJSUM, Masamitsu NAKAMURA, SJUSM,
Ryu MATSUOKA, SJUSM, Kiyotake ICHIDUKA, SJUSM, Akihiko SEKIZAWA
Abstract
We herein report a case with uterine corneal rupture that occurred at 28 weeks of gestation. The patient was a 30-year-old
primigravida without any history of uterine surgery. She had undergone regular pregnancy check-ups from the ﬁrst
trimester, and a normally located gestational sac had been conﬁrmed by ultrasound at 8 weeks of gestation. She was
admitted to our hospital for uterine contractions and genital bleeding at 26 weeks of gestation. On admission, a soft mass
was felt by palpation at the left lateral region of the abdomen. An ultrasound examination revealed that the mass
protruded from the uterine corneal position and had folded placenta in the mass. Threatened uterine rupture was
suspected. At 27 weeks’ gestation, a reticular low echo area（39 × 24 mm）at the margin of the placenta was visualized.
Along with frequent uterine contractions and tenderness of the mass at 28 weeks’ gestation, the low echo area increased at
the margin of the placenta. Prolonged deceleration was also observed. A diagnosis of uterine rupture and placental
abruption was made, and an emergency cesarean section was performed. The blood loss during the operation was 1065 g.
A 1173 g healthy neonate was born with an Apgar score（1 / 5 min）of 8 / 9. The bulging lesion at the left corneal position
was observed, and the myometrium was noted to be thin and ruptured. Similar to the antenatal diagnosis, a uterine rupture
from the corneal position of the placenta was diagnosed. Wedge resection of the ruptured uterus at the corneal position
was performed using three-layered sutures. Uterine rupture may occur when the placenta is located abnormally, even in
cases at low risk for uterine rupture without a past history or perinatal characteristics.
Keywords
corneal position of uterus, placental abruption, uterine contraction
1．はじめに
が必要である．今回我々は，妊娠初期に子宮内に胎
嚢を認め，妊娠 28 週に卵管角の胎盤付着部位から
子宮破裂は頻度の低い疾患ではあるが，母児とも
子宮破裂を引き起こした症例を経験したので報告す
に重篤な状態に陥る可能性があり，遅滞のない対応
る．
昭和大学産婦人科学講座
Department of Obstetrics and Gynecology, Showa University School of Medicine, 1︲5︲8 Hatanodai, Shinagawa, Tokyo 142︲8666, Japan
Received on September 25, 2014; Revision accepted on November 15, 2014 J-STAGE. Advanced published. date: February 6, 2015
Jpn J Med Ultrasonics

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