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- 저자 : 전춘희(HC Chun) (검색결과 1 건)
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안정례(CR Ahn),이순해(SB Rhee),전춘희(HC Chun),조면호(MH Cho) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.2
In the 6 year period from Jan. 1961 to Dec. 1966, a single case of spontaneous rupture of intact preg- nant uterus during labor was experienced in a total of 11,111 deliveries at Ewhn Womans University Hospital, Seoul. The patient, gravida 7, para 3, 31 year of age, term pregnant woman was admitted into the labor room in Nov. 30, 1966 with ceasing pain following some 4½ hours active labor pain at home. The past history revealed that only she has had two times early spontaneous abortions and a tubal pregnancy of one year previousely. On the admission the cervix was fully dilated but without progressing and the pressenting part of the vertex was completely engaged. The B.P. was 90/0, pulse 132/min. The oxygen mask was applied to the patient although there was no any restlessness or pale appearance 2½ hour after the admission, X-ray pelvimetry was taken and showed a suggestive of borderline transvevese arrest although she has had 3 times normal vaginal deliveries previousely. She developed two times vomitings, then the B.P. suddenly dropped to 70/0 or 50/0, became pale, and evidently is in the shock. The abdomen, however, was so soft and the two different prominent parts could be palpated, suggestive of the fetal head and uterrine fundus. During the immediated laparatomy the B.P. was controlled by giving 5,000 c.c. of blood transfusion and total hysterectomy was performed in good condition for the longitudinal spontaeous rupture of left low portion of the uterus extending to the upper vaginal wall. In the spontaneous rupture of the uterus during labor or advanced stage especially in the lateral longi- tudinal rupture, the bleeding from the proximal end of the severed uterine artery seems tend to stop temporally probably due to the accumulated blood clots in the limited retroperitoneal space occuring the inital stage of the rupture. The bleeding from the lateral vesical plexus, however, was so proguse, never seemed to be stopped anatomically by the natural clotting mechanism. We would like to emphasize that searching and ligation of the silent proximal end of the uterine artery, masking in the numerous clots should never be missed since it will subseqquently pop up by the time of the clots resolution take place in 4~5 days as well as the B.P. back to normal level.
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