两次剖宫产史后孕中期联体双胎经阴道引产一例  

Second-trimester termination due to conjoined twins in a woman with twice previous cesarean sections

作　　者：曾勇[1] 张续丰 何文容[1] Zeng Yong;Zhang Xufeng;He Wenrong(Department of Obstetrics,the First People's Hospital Affiliated to Yangtze University,Jingzhou First People's Hospital,Jingzhou 434000,China)

机构地区：[1]长江大学附属第一人民医院,湖北省荆州市第一人民医院产科,434000

出　　处：《中华围产医学杂志》2021年第11期847-850,共4页Chinese Journal of Perinatal Medicine

基　　金：湖北省卫健委医药院校专项基金(WJ2018H175)。

摘　　要：本文报告了1例瘢痕子宫孕中期联体双胎经阴道引产成功的病例。孕妇25岁,有2次剖宫产史,末次于2017年行剖宫产。本次孕19周+5常规产前超声显示胸腹部联体双胎、共同心脏、羊水过多,于孕20周+1入院。入院后多学科会诊充分评估胎儿及母体产道情况,排除阴道引产绝对禁忌证,行阴道引产,方案为米非司酮300 mg口服+依沙吖啶100 mg羊膜腔注射。该孕妇于羊膜腔注射28 h后临产。引产过程中协助臀位分娩,孕妇于孕20周+6娩出联体女性死胎2具。引产过程顺利,无软产道损伤,出血量约150 ml。引产后对死胎行病理检查,大体标本可见双胎胸腹联体畸形,病理解剖后可见共用心脏、肝脏畸形。充分的产前检查评估,严格把握阴道引产指征,产程中严密监测,以及做好紧急剖宫产准备等,是瘢痕子宫孕中期联体双胎经阴道引产的重要的安全保障措施。We report the induced labor of conjoined twins in the second trimester in a woman with a history of two previous cesarean sections,the last one of which was performed in 2017.This 25-year-old patient was found to have thoracolumbar conjoined fetuses with one heart and polyhydramnios through the routine ultrasound examination at 19+5 gestational weeks and was admitted at 20+1 gestational weeks.After a full assessment of the fetal and maternal condition through multidisciplinary consultation,it was determined to attempt a vaginal delivery as no absolute contraindication for induction of labor.The patient was given 300 mg mifepristone orally plus an amniotic cavity injection of 100 mg ethacridine lactate.Regular contractions occurred 28 hours after medication.The patient delivered a pair of dead female conjoined twins at 20+6 gestational weeks following successful induction of labor,with an assisted vaginal breech delivery.There was no soft tissue damage in the birth canal,and the estimated blood loss was 150 ml.Pathological examination and autopsy showed thoracolumbar conjoined deformity twins with a common heart and liver.Adequate prenatal evaluation,a detailed understanding of the indications for induction of labor and vaginal delivery,closed monitoring during labor,and preparation for emergency cesarean section,are essential safety measures for induced labor of conjoined twins in women with a scarred uterus in the second trimester.

关 键 词：瘢痕 妊娠中期 联体双胎 引产 

分 类 号：R719.3[医药卫生—妇产科学]