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An obstetric DIC caused with prolonged bleeding due to uterine inversion
子宮内反症から産科DICを発症しながらも救命し得た一症例

茂木, 康一 ; 佐藤, 正章 ; 瀬尾, 憲正 ; Mogi, Kouichi ; Sato, Masaaki ; Seo, Norimasa

蘇生, 2011, Vol.30(1), pp.23-26

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  • An obstetric DIC caused with prolonged bleeding due to uterine inversion

  • Title:
    子宮内反症から産科DICを発症しながらも救命し得た一症例
  • Author: 茂木, 康一 ; 佐藤, 正章 ; 瀬尾, 憲正 ; Mogi, Kouichi ; Sato, Masaaki ; Seo, Norimasa
  • Subjects: 子宮内反症 ; 産科DIC ; Uterine Inversion ; Obstetric Dic
  • Is Part Of: 蘇生, 2011, Vol.30(1), pp.23-26
  • Description:  我々は産科DIC を発症した子宮内反症の麻酔管理を経験したので報告する。症例は25歳の初産婦。自然分娩直後から子宮内反症による大量出血を来した。徒手整復術は奏功せず,救命目的に救急搬送された。意識下挿管後,麻酔はセボフルランとフェンタニルで維持した。産科DIC スコアは上昇し,収縮機能不全となった子宮からの止血が困難となった。そのため,原因子宮の摘出と輸血療法を行った。術後はICU 管理を行い,術後7日目には独歩退院した。内反症は必ずしも産科DIC と直結しない。しかし収縮機能不全に陥った子宮は産科DIC を惹起しうる。産科DIC には正確な臨床評価,他科との速やかな連携及び集学的治療が重要である。
     A 25-year-old, 44-kg, 157-cm premigravia delivered her baby on the 39th weeks and first day. She was transferred to our hospital because of uterine inversion and uncontrollable bleeding. Her systolic blood pressure was 80-90 mmHg ; SpO2 was 100% and heart rate was 95-105 bpm. Preoperative laboratory data showed Hb 4.3g/dl, Hct 13.2 % and plt 18.3X104/mm3. The preoperative assessment indicated she was in hypovolemic shock. Awake intubation and general anesthesia was planned. Awake intubation was gently performed with topical anesthesia and general anesthesia followed with sevoflurane, fentanyl and rocuronium under 100 % oxygen. During the operation, the score of DIC was up to 15 induced with prolonged bleeding from afunctional uterine. The total of MAP 20 units, FFP 20 units and Platlet 10 units were transfused. By total hysterectomy of atonic uterine, the surgery was successfully finished. After the operation, her vital signs and DIC score were soon restored in the ICU. The patient had uneventful postoperative recovery. Although uterine inversion rarely lead to obstetric DIC, this case indicated that the clinical assessment with obstetric DIC in mind and the communication with obstetricians are the core for obstetric anesthesia.
  • Language: Japanese
  • Identifier: ISSN: 0288-4348 ; DOI: 10.11414/jjreanimatology.30.23

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