پارگی کلدوساک خلفی، عارضه نادر به دنبال سزارین در موارد جایگاه پایین سر جنین: یک گزارش موردی

نوع مقاله: گزارش مورد

نویسندگان

1 استادیار گروه زنان و مامایی،‌ مرکز تحقیقات سلامت زنان، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 متخصص بیهوشی،‌ دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، ‌مشهد،‌ ایران.

چکیده

مقدمه: دشوار بودن خروج جنین در حین سزارین، در 2-1% موارد رخ می دهد که یکی از علل آن، پک شدن سرجنین در کانال زایمان می باشد که با عوارض مادری و جنینی زیادی همراه است. در این گزارش،‌ خانم 26 ساله ای معرفی شده که به دلیل سزارین در جایگاه پایین، دچار پارگی کلدوساک خلفی شد که یک عارضه نادر می باشد.
معرفی بیمار: بیمار خانم 26 ساله حاملگی اول و ترم بود که به دلیل درد زایمانی در فاز فعال زایمانی به بیمارستان مراجعه کرد. بیمار در مرحله دوم زایمان به دلیل افت طولانی ضربان قلب جنین جهت سزارین به اتاق عمل منتقل شد. به دلیل پک بودن سر جنین در کانال زایمان، ‌دستیار از واژن سر را به بالا رانده تا جراح بتواند جنین را خارج کند (روش ابدومینوواژینال)، ولی به دلیل عدم موفقیت این روش،‌ جنین با روش کششی بریچ خارج شد. پس از آن‌ متوجه پارگی کلدوساک خلفی به طول 4 سانتی متر شدیم که پارگی ترمیم و شکم بسته شد و بیمار بعد از 72 ساعت با حال عمومی خوب و بدون وجود علائم عفونت مرخص شد.
نتیجه گیری: آسیب ارگان های مجاور رحم و لیگامان ها به عنوان عارضه کلی سزارین در جایگاه پایین ذکر شده است که جراح بایستی در موقع ترمیم محل سزارین در موارد جایگاه پایین به این عوارض توجه خاصی داشته باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Rupture of posterior cul-de-sac: a rare complication following cesarean in low station of fetal head: a case report

نویسندگان [English]

  • Seyedeh Houra Vahedalain 1
  • Malihe Afiat 1
  • Seyed Mostafa Pashang 2
1 Assistant professor, Department of Obstetrics and Gynecology, Women's Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Anesthesiologist, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده [English]

Introduction: Fetal extraction difficulty during cesarean delivery occurs in 1 to 2% of cases that one of the causes is impacted fetal head in delivery canal which is associated with many fetal and maternal complications. In this report, we introduce a 26 years old woman who is complicated with rupture of posterior cul-de-sac during cesarean in low station of fetal head which is a rare complication.
Case presentation: A 26 years old woman with first pregnancy at term presented to the hospital with labor pain in active phase of labor. In the second stage of labor, she was transferred to operative room for cesarean section due to prolonged deceleration of fetal heart rate (FHR). Because of impacted fetal head in delivery canal, the assistant placed her hand into the vagina to push the fetal head up into the uterus in order to surgeon can extract the fetus (abdominovaginal method). But this method was unsuccessful and fetus was extracted with reverse breech extraction method. Then we noticed rupture of posterior cul-de-sac in length 4-cm and it was repaired and the abdomen was closed. Patient was discharged after 72 hours with good condition and no signs and symptoms of infection.
Conclusion: Damage to the adjacent tissues and ligaments of the uterus is mentioned as a complication of performing cesarean in low station that the surgeon should pay special attention to these complications when repairing the caesarean site in cases of low station.

کلیدواژه‌ها [English]

  • Abdominovaginal method
  • Low station
  • Reverse breech extraction method
  • Rupture of posterior cul-de-sac
  • Second stage of labor
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