孕中期未产孕妇自发性腹膜内出血致母胎死亡1例。

Q2 Medicine
N Pascale, G Bertozzi, M Ferrara, M Treglia, M Calvano, A Di Fazio
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引用次数: 0

摘要

背景:自发性腹膜内出血是一种罕见且潜在致命的疾病,历史上被称为“腹腔中风”。它是指一个或多个小内脏血管的非创伤性和非医源性破裂,引起大量腹部出血。一般来说,腹膜出血可能与多种原因有关,然而,在其他情况下,如妊娠期自发性腹膜出血,其病因尚不清楚。病例报告:病例33岁,其他方面健康,无创伤史,初孕-23周提出。在公共场所的一次晚宴上,它处理了突然发展起来的震惊状态。急救人员赶到时,她已经死了。由于怀疑救援延误,决定进行司法尸检。完整的尸检显示大量腹膜出血,没有出血的来源;组织学检查证实为低血容量性休克伴肠黏膜缺氧缺血性损伤。综上所述,死亡原因是由自发性自发性腹膜内出血引起的低血容量性休克。在紧急救援中不承担任何责任。讨论:在类似的出血病因不明的病例中,假设是怀孕期间血管的反复扩张,加上血管壁的缺陷或变薄,容易导致血管破裂,导致不明来源的出血,可能涉及腹腔轴的分支。本病例提示,当孕妇出现非典型和不相关的症状时,需要考虑对这种情况的诊断怀疑。据我们所知,没有多少病例报告的出血如此之多,在这种情况下,出血点是模糊的。由于这些评估,医疗保健专业人员的责任被排除在外。因此,在所有类似的情况下,无论是临床还是司法解剖,都是强制性的,既是为了分析作为风险管理工具的过程,也是为了从医学-法律角度进行经济评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Case of Maternal and Fetal Death by Idiopathic spontaneous intraperitoneal hemorrhage in a nulliparous Pregnant at the Second Trimester.

Background: Spontaneous intraperitoneal hemorrhage is a rare and potentially fatal condition historically known as "abdominal apoplexy". It refers to the non-traumatic and non-iatrogenic rupture of one or more small splanchnic vessels causing massive abdominal bleeding. In general, hemoperitoneum can be associated with various causes, however, in other cases, known as spontaneous hemoperitoneum during pregnancy, the etiology remains unidentified.

Case report: The case of a 33-year-old, otherwise healthy and with no traumatic history, primigravida-23-week pregnant is presented. It dealt with a suddenly developed shock status, during a dinner in a public place. At Emergency Service arrival, she was already dead. A judicial autopsy was decided, in suspect of a rescue delay. The full autopsy showed a massive hemoperitoneum, with no origin of hemorrhage; the histological examination confirmed the hypovolemic shock with hypoxic-ischemic suffering of the intestinal mucosa. In conclusion, the cause of death was attributed to a hypovolemic shock due to idiopathic spontaneous intraperitoneal hemorrhage. Any responsibility in Rescue Emergency was excluded.

Discussion: In similar cases of unknown bleeding etiopathogenesis, the hypothesis is that the repeated distension of the vessels during pregnancy, together with defects or thinning of the vascular wall, predisposes to its rupture, causing bleeding with no identifiable origin, probably involving branch of the celiac axis. The present case suggests the need to consider the diagnostic suspicion of this condition when atypical and unrelated symptoms in pregnant women appeared. To the best of our knowledge not many cases reported as much ble-eding as in this case whereby the bleeding point was obscured. As a result of these assessments, the liability of healthcare professionals was excluded. Therefore, in all analogous cases the autopsy, clinical or judicial, is mandatory both for the analysis of the process as a tool for risk management, and for the economic evaluation from a medico-legal perspective.

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来源期刊
Clinica Terapeutica
Clinica Terapeutica PHARMACOLOGY & PHARMACY-
CiteScore
2.50
自引率
0.00%
发文量
124
审稿时长
6-12 weeks
期刊介绍: La Clinica Terapeutica è una rivista di Clinica e Terapia in Medicina e Chirurgia, fondata nel 1951 dal Prof. Mariano Messini (1901-1980), Direttore dell''Istituto di Idrologia Medica dell''Università di Roma “La Sapienza”. La rivista è pubblicata come “periodico bimestrale” dalla Società Editrice Universo, casa editrice fondata nel 1945 dal Comm. Luigi Pellino. La Clinica Terapeutica è indicizzata su MEDLINE, INDEX MEDICUS, EMBASE/Excerpta Medica.
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