子宫复旧异常可能导致张力和产后出血:一个假说,并回顾证据。

IF 1.3 4区 医学 Q3 PATHOLOGY
Pediatric and Developmental Pathology Pub Date : 2023-09-01 Epub Date: 2023-09-06 DOI:10.1177/10935266231194698
Debra S Heller, Stewart F Cramer, Bradley M Turner
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引用次数: 0

摘要

子宫复旧有两个主要组成部分:(1)血管复旧;(2)肌层内陷。1945年,卢瑟福和赫蒂希研究了船只的内化问题;然而,在现代文献中,肌层内翻很少受到关注。我们认为子宫肌膜复旧的病理生理可能导致子宫张力和产后出血。由于胎儿肾上腺皮质和胎盘的激素影响,妊娠期肌细胞增生和肥大导致子宫肌层急剧增大。分娩后,子宫重量迅速下降,肌层的生理性复旧与肌层组织的大量破坏有关。由此产生的组织病理学,有科学证据支持,可称为“产后metroopathy”,并可以解释产后月经延迟直到完全复旧。当子宫张力引起无法控制的出血时,产后子宫切除术检查可能是围产期病理学家的责任。产后metroopathy可能在分娩终止胎儿肾上腺皮质激素影响时开始,并可能在胎盘分娩终止人绒毛膜促性腺激素(HCG)暴露时加速。这一假说可以解释为什么第三产褥期延长和处理延误是子宫张力所致严重出血的危险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Abnormal Uterine Involution May Lead to Atony and Postpartum Hemorrhage: A Hypothesis, With Review of the Evidence.

Uterine involution has 2 major components-(1) involution of vessels; and (2) involution of myometrium. Involution of vessels was addressed by Rutherford and Hertig in 1945; however, involution of myometrium has received little attention in the modern literature. We suggest that the pathophysiology of myometrial involution may lead to uterine atony and postpartum hemorrhage. The myometrium dramatically enlarges due to gestational hyperplasia and hypertrophy of myocytes, caused by hormonal influences of the fetal adrenal cortex and the placenta. After delivery, uterine weight drops rapidly, with physiologic involution of myometrium associated with massive destruction of myometrial tissue. The resulting histopathology, supported by scientific evidence, may be termed "postpartum metropathy," and may explain the delay of postpartum menstrual periods until the completion of involution. When uterine atony causes uncontrolled hemorrhage, postpartum hysterectomy examination may be the responsibility of the perinatal pathologist.Postpartum metropathy may be initiated when delivery of the baby terminates exposure to the hormonal influence of the fetal adrenal cortex, and may be accelerated when placental delivery terminates exposure to human chorionic gonadotrophin (HCG). This hypothesis may explain why a prolonged third stage of labor, and delays in management, are risk factors for severe hemorrhage due to uterine atony.

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来源期刊
CiteScore
3.70
自引率
5.30%
发文量
59
审稿时长
6-12 weeks
期刊介绍: The Journal covers the spectrum of disorders of early development (including embryology, placentology, and teratology), gestational and perinatal diseases, and all diseases of childhood. Studies may be in any field of experimental, anatomic, or clinical pathology, including molecular pathology. Case reports are published only if they provide new insights into disease mechanisms or new information.
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