妊娠期和产褥期女性腹痛和急腹症的处理
- Authors
- Charlie C Kilpatrick, MD
Charlie C Kilpatrick, MD
- Associate Professor, Female Pelvic Medicine and Reconstructive Surgery
- Department of Obstetrics and Gynecology
- Baylor College of Medicine
- Francisco J Orejuela, MD
Francisco J Orejuela, MD
- Associate Professor
- Department of Obstetrics and Gynecology Female Pelvic Medicine and Reconstructive Surgery
- Baylor College of Medicine
- Section Editors
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- The American Board of Obstetrics and Gynecology (ABOG)
- Martin Weiser, MD
Martin Weiser, MD
- Section Editor — Colorectal Surgery
- Professor of Surgery
- Weill Cornell Medical College
- Member
- Memorial Sloan Kettering Cancer Center
- Deputy Editor
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Translators
- 许张晔, 主任医师,副教授
许张晔, 主任医师,副教授
- 温州医科大学附属第二医院产科
引言
妊娠期腹痛和急腹症的处理与非妊娠状态时类似,但也存在一些额外的挑战。例如,临床医生需要考虑与妊娠、孕龄和胎儿状态相关的生理/解剖变化,以及可能更常由妊娠状态引起或与产科并发症相关的急腹症病因。应采取必要的诊断性影像学检查和干预措施,因为诊断和治疗延迟可增加母体和胎儿/新生儿的并发症发病率和死亡率[1,2]。
本专题将总结妊娠期及产褥期女性腹痛和急腹症相关的诊断性评估和处理。其他人群腹痛和急腹症的概述将单独讨论:
●(参见“成年人腹痛的诊断方法”)
●(参见“成人腹痛的鉴别诊断”)
●(参见“女性急性盆腔痛的评估”)
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- Kilpatrick CC, Orejuela FJ. Management of the acute abdomen in pregnancy: a review. Curr Opin Obstet Gynecol 2008; 20:534.
- Parangi S, Levine D, Henry A, et al. Surgical gastrointestinal disorders during pregnancy. Am J Surg 2007; 193:223.
- Cormier CM, Canzoneri BJ, Lewis DF, et al. Urolithiasis in pregnancy: Current diagnosis, treatment, and pregnancy complications. Obstet Gynecol Surv 2006; 61:733.
- Stone K. Acute abdominal emergencies associated with pregnancy. Clin Obstet Gynecol 2002; 45:553.
- Ryan JP, Pellecchia D. Effect of ovarian hormone pretreatment on gallbladder motility in vitro. Life Sci 1982; 31:1445.
- Lurie S, Rahamim E, Piper I, et al. Total and differential leukocyte counts percentiles in normal pregnancy. Eur J Obstet Gynecol Reprod Biol 2008; 136:16.
- Acker DB, Johnson MP, Sachs BP, Friedman EA. The leukocyte count in labor. Am J Obstet Gynecol 1985; 153:737.
- Baron KT, Arleo EK, Robinson C, Sanelli PC. Comparing the diagnostic performance of MRI versus CT in the evaluation of acute nontraumatic abdominal pain during pregnancy. Emerg Radiol 2012; 19:519.
- Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E. MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics 2012; 32:317.
- Beddy P, Keogan MT, Sala E, Griffin N. Magnetic resonance imaging for the evaluation of acute abdominal pain in pregnancy. Semin Ultrasound CT MR 2010; 31:433.
- Groen RS, Bae JY, Lim KJ. Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol 2012; 206:456.
- Brosens IA, Fusi L, Brosens JJ. Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. Fertil Steril 2009; 92:1243.
- Bloom SL, Uppot R, Roberts DJ. Case records of the Massachusetts General Hospital. Case 32-2010. A pregnant woman with abdominal pain and fluid in the peritoneal cavity. N Engl J Med 2010; 363:1657.
- Fiori O, Prugnolles H, Darai E, et al. Spontaneous uterine artery rupture during pregnancy in a woman with sickle cell disease: a case report. J Reprod Med 2007; 52:657.
- Swaegers MC, Hauspy JJ, Buytaert PM, De Maeseneer MG. Spontaneous rupture of the uterine artery in pregnancy. Eur J Obstet Gynecol Reprod Biol 1997; 75:145.
- Practice Committee of American Society For Reproductive Medicine. Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome. Fertil Steril 2012; 97:282.
- la Chapelle CF, Schutte JM, Schuitemaker NW, et al. Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry. BJOG 2012; 119:86.
- Chao LW, Chen CH. Spontaneous rupture of an ovarian artery aneurysm: case report and review of the literature. Gynecol Obstet Invest 2009; 68:104.
- Sakaguchi I, Ohba T, Ikeda O, et al. Embolization for post-partum rupture of ovarian artery aneurysm: case report and review. J Obstet Gynaecol Res 2015; 41:623.
- Ramin KD, Ramin SM, Richey SD, Cunningham FG. Acute pancreatitis in pregnancy. Am J Obstet Gynecol 1995; 173:187.
- Papadakis EP, Sarigianni M, Mikhailidis DP, et al. Acute pancreatitis in pregnancy: an overview. Eur J Obstet Gynecol Reprod Biol 2011; 159:261.
- Karsenti D, Bacq Y, Bréchot JF, et al. Serum amylase and lipase activities in normal pregnancy: a prospective case-control study. Am J Gastroenterol 2001; 96:697.
- Ordorica SA, Frieden FJ, Marks F, et al. Pancreatic enzyme activity in pregnancy. J Reprod Med 1991; 36:359.
- Kaiser R, Berk JE, Fridhandler L. Serum amylase changes during pregnancy. Am J Obstet Gynecol 1975; 122:283.
- Xydas NP, May JH, Henson MC. Maternal serum amylase and lipase profiles in pregnancy: determinations in both once-sampled and multisampled patient cohorts. South Med J 1996; 89:199.
- Huang SC, Wu TH, Chen CC, Chen TC. Spontaneous rupture of solid pseudopapillary neoplasm of the pancreas during pregnancy. Obstet Gynecol 2013; 121:486.
- Kakarla N, Dailey C, Marino T, et al. Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol 2005; 105:1195.
- Chase DM, Sparks DA, Dawood MY, Perry E. Cecal volvulus in a multiple-gestation pregnancy. Obstet Gynecol 2009; 114:475.
- Essilfie P, Hussain M, Bolaji I. Perforated duodenal ulcer in pregnancy-a rare cause of acute abdominal pain in pregnancy: a case report and literature review. Case Rep Obstet Gynecol 2011; 2011:263016.
- Sadat U, Dar O, Walsh S, Varty K. Splenic artery aneurysms in pregnancy--a systematic review. Int J Surg 2008; 6:261.
- Selo-Ojeme DO, Welch CC. Review: spontaneous rupture of splenic artery aneurysm in pregnancy. Eur J Obstet Gynecol Reprod Biol 2003; 109:124.
- Karmazyn B, Steinberg R, Gayer G, et al. Wandering spleen--the challenge of ultrasound diagnosis: report of 7 cases. J Clin Ultrasound 2005; 33:433.
- Tolcher MC, Nitsche JF, Arendt KW, Rose CH. Spontaneous rectus sheath hematoma pregnancy: case report and review of the literature. Obstet Gynecol Surv 2010; 65:517.
- Bockorny B, Posteraro A, Bilgrami S. Bilateral spontaneous adrenal hemorrhage during pregnancy. Obstet Gynecol 2012; 120:377.
- Tamir IL, Bongard FS, Klein SR. Acute appendicitis in the pregnant patient. Am J Surg 1990; 160:571.
- Huerta S, Barleben A, Peck MA, Gordon IL. Meckel's diverticulitis: a rare etiology of an acute abdomen during pregnancy. Curr Surg 2006; 63:290.
- Ragu N, Tichoux C, Bouyabrine H, et al. [Complicated diverticulitis during pregnancy]. J Radiol 2004; 85:1950.
- Bodner J, Windisch J, Bale R, et al. Perforated right colonic diverticulitis complicating pregnancy at 37 weeks' gestation. Int J Colorectal Dis 2005; 20:381.
- Chanrachakul B, Tangtrakul S, Herabutya Y, et al. Meckel's diverticulitis: an uncommon complication during pregnancy. BJOG 2001; 108:1199.
- Sherer DM, Frager D, Eliakim R. An unusual case of diverticulitis complicating pregnancy at 33 weeks' gestation. Am J Perinatol 2001; 18:107.
- Pelosi MA 3rd, Pelosi MA, Villalona E. Right-sided colonic diverticulitis mimicking acute cholecystitis in pregnancy: case report and laparoscopic treatment. Surg Laparosc Endosc 1999; 9:63.
- Wong YS, Liu SY, Ng SS, et al. Giant Meckel's diverticulitis: a rare condition complicating pregnancy. Am J Surg 2010; 200:184.
- Longo SA, Moore RC, Canzoneri BJ, Robichaux A. Gastrointestinal Conditions during Pregnancy. Clin Colon Rectal Surg 2010; 23:80.
- Johansson ME, Holmström S, Abebe A, et al. Intrauterine fetal death due to echovirus 11. Scand J Infect Dis 1992; 24:381.
- Modlin JF. Fatal echovirus 11 disease in premature neonates. Pediatrics 1980; 66:775.
- Woodfield CA, Lazarus E, Chen KC, Mayo-Smith WW. Abdominal pain in pregnancy: diagnoses and imaging unique to pregnancy--review. AJR Am J Roentgenol 2010; 194:WS14.
- Atakan Al R, Borekci B, Ozturk G, et al. Acute mesenteric venous thrombosis due to protein S deficiency in a pregnant woman. J Obstet Gynaecol Res 2009; 35:804.
- Engelhardt TC, Kerstein MD. Pregnancy and mesenteric venous thrombosis. South Med J 1989; 82:1441.
- Nelson DB, Manders DB, Shivvers SA. Primary iliopsoas abscess and pregnancy. Obstet Gynecol 2010; 116 Suppl 2:479.
- Young OM, Werner E, Sfakianaki AK. Primary psoas muscle abscess after an uncomplicated spontaneous vaginal delivery. Obstet Gynecol 2010; 116 Suppl 2:477.
- Delke I. Psoas abscess in obstetrics: uncommon condition with common presentations. Obstet Gynecol 2010; 116 Suppl 2:473.
- Hasson J, Tsafrir Z, Azem F, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 2010; 202:536.e1.
- Smorgick N, Pansky M, Feingold M, et al. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Fertil Steril 2009; 92:1983.
- Chohan L, Ramirez MM, Wray CJ, Kilpatrick CC. Laparoscopic management of fallopian tube torsion at 35 weeks of gestation: case report. J Minim Invasive Gynecol 2011; 18:390.
- De Ioris A, Pezzuto C, Nardelli GB, Modena AB. Caesarean delivery through deliberate posterior hysterotomy in irreducible uterine torsion: case report. Acta Biomed 2010; 81:141.
- Cook KE, Jenkins SM. Pathologic uterine torsion associated with placental abruption, maternal shock, and intrauterine fetal demise. Am J Obstet Gynecol 2005; 192:2082.
- Guié P, Adjobi R, N'guessan E, et al. Uterine torsion with maternal death: our experience and literature review. Clin Exp Obstet Gynecol 2005; 32:245.
- Fatih FF, Gowri V, Rao K. Uterine torsion in second trimester of pregnancy followed by a successful-term pregnancy. BMJ Case Rep 2012; 2012.
- Salani R, Theiler RN, Lindsay M. Uterine torsion and fetal bradycardia associated with external cephalic version. Obstet Gynecol 2006; 108:820.
- Albayrak M, Benian A, Ozdemir I, et al. Deliberate posterior low transverse incision at cesarean section of a gravid uterus in 180 degrees of torsion: a case report. J Reprod Med 2011; 56:181.
- Strobelt N, Ghidini A, Cavallone M, et al. Natural history of uterine leiomyomas in pregnancy. J Ultrasound Med 1994; 13:399.
- Aharoni A, Reiter A, Golan D, et al. Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study. Br J Obstet Gynaecol 1988; 95:510.
- Neiger R, Sonek JD, Croom CS, Ventolini G. Pregnancy-related changes in the size of uterine leiomyomas. J Reprod Med 2006; 51:671.
- Murray A, Holdcroft A. Incidence and intensity of postpartum lower abdominal pain. BMJ 1989; 298:1619.
- Holdcroft A, Snidvongs S, Cason A, et al. Pain and uterine contractions during breast feeding in the immediate post-partum period increase with parity. Pain 2003; 104:589.
- Ducarme G, Lidove O, Leduey A, et al. Postpartum thrombosis of the superior mesenteric artery after vaginal delivery. Obstet Gynecol 2008; 111:535.
- Garey KW, Jiang ZD, Yadav Y, et al. Peripartum Clostridium difficile infection: case series and review of the literature. Am J Obstet Gynecol 2008; 199:332.
- Rouphael NG, O'Donnell JA, Bhatnagar J, et al. Clostridium difficile-associated diarrhea: an emerging threat to pregnant women. Am J Obstet Gynecol 2008; 198:635.e1.
- Patel A, Lall CG, Jennings SG, Sandrasegaran K. Abdominal compartment syndrome. AJR Am J Roentgenol 2007; 189:1037.
- Anteby EY, Yagel S, Hanoch J, et al. Puerperal and intrapartum group A streptococcal infection. Infect Dis Obstet Gynecol 1999; 7:276.
- de Moya MA, del Carmen MG, Allain RM, et al. Case records of the Massachusetts General Hospital. Case 33-2009. A 35-year-old woman with fever, abdominal pain, and hypotension after cesarean section. N Engl J Med 2009; 361:1689.
- Hamilton SM, Stevens DL, Bryant AE. Pregnancy-related group a streptococcal infections: temporal relationships between bacterial acquisition, infection onset, clinical findings, and outcome. Clin Infect Dis 2013; 57:870.
- Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy. J Am Coll Cardiol 2008; 52:171.
- Koul AK, Hollander G, Moskovits N, et al. Coronary artery dissection during pregnancy and the postpartum period: two case reports and review of literature. Catheter Cardiovasc Interv 2001; 52:88.
- Petitti DB, Sidney S, Quesenberry CP Jr, Bernstein A. Incidence of stroke and myocardial infarction in women of reproductive age. Stroke 1997; 28:280.
- Mather PJ, Hansen CL, Goldman B, et al. Postpartum multivessel coronary dissection. J Heart Lung Transplant 1994; 13:533.
- Pabla JS, John L, McCrea WA. Spontaneous coronary artery dissection as a cause of sudden cardiac death in the peripartum period. BMJ Case Rep 2010; 2010.
Topic Outline- 引言
- 一般原则
- 诊断性评估
- 病史和体格检查
- 实验室检查
- 影像学
- - 电离辐射
- 腹腔镜检查
- 腹痛的鉴别诊断
- 与妊娠相关的病因
- - 妊娠前半期
- 流产
- 宫外孕(异位妊娠)
- - 妊娠后半期
- 临产
- 胎盘早剥
- 子宫破裂
- 妊娠相关的肝病
- - 重度子痫前期
- - HELLP综合征
- - 急性脂肪肝
- 羊膜腔内感染
- 自发性腹腔积血
- 子宫嵌顿
- 动脉夹层和破裂
- 非妊娠相关性病因
- - 上腹部疼痛
- 胃食管反流
- 胆囊疾病
- 急性肝炎
- 胰腺疾病
- 肺炎
- 肠梗阻
- 穿孔性溃疡
- 脾脏疾病
- 食管裂孔疝
- 腹直肌鞘血肿
- 肾上腺出血
- - 下腹部疼痛
- 急性阑尾炎
- 肾结石
- 炎症性肠病
- 憩室炎
- - 弥漫性腹痛或疼痛位置不一
- 镰状细胞危象
- 创伤
- 肠胃炎
- 肠系膜静脉血栓形成
- 髂腰肌脓肿
- 腹壁疼痛
- 腹壁疝
- 遗传性血管性水肿
- 妇科原因
- - 卵巢扭转
- - 输卵管扭转
- - 子宫扭转
- - 卵巢囊肿破裂或出血
- - 纤维瘤变性或扭转
- - 盆腔炎性疾病
- 产褥期腹痛
- - 子宫内膜炎
- - 切口并发症
- - 坏死性筋膜炎
- - 卵巢血栓性静脉炎
- - 艰难梭菌性腹泻和结肠炎
- - 尿潴留
- - 出血
- - 无动力性肠梗阻和急性结肠假性梗阻(Ogilvie综合征)
- - 肝脏增大和破裂
- - 腹腔间隔室综合征
- - 耻骨联合分离
- - 异物
- - 未被发现的内脏损伤
- - 腹腔内或盆腔脓肿、外科软组织感染
- - 心肌梗死
- 患者教育
- 总结与推荐
- REFERENCES
GRAPHICS
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