NEJMのイメージから・・・お腹のMRI

フランスからMRIイメージである。このMRIイメージからこの女性のお腹になにが起こっているかを診断してもらいたい。やはり矢印に挟まれた構造物であろうが、よくみると背後にミラーイメージのようにもうひとつの構造物がある。

・・・温泉に入った大門未知子のようなイメージ・・というとわかりやすいか？

Images in Clinical Medicine

A 33-year-old asymptomatic woman (gravida 6, para 5) presented at 22 weeks of gestation with a large herniation of the amniotic sac through the left uterine wall that was detected by routine ultrasonography. She had had five previous cesarean sections through a transverse incision of the lower uterine segment and no previous vaginal deliveries. Magnetic resonance imaging revealed a 2.5-cm rupture of the left uterine wall (arrows) and a large amniocele that measured 19 cm by12 cm by 9 cm and contained fetal legs. The patient and her partner were informed of the potential risks of these findings, including complete uterine rupture, placenta accreta, hysterectomy, and preterm birth. They opted to proceed with the pregnancy with close monitoring. Repeat ultrasonography at 30 weeks of gestation revealed that the uterine dehiscence had extended 5 cm and the herniated sac had grown and included the fetal abdomen and legs. At 30 weeks of gestation, a healthy male newborn weighing 1385 g was delivered by cesarean section. After the delivery, the left posterior uterine rupture and large amniocele were identified and repaired. The patient had an uncomplicated postoperative course and was discharged from the hospital 5 days later. At 6 months of age, the baby was alive and well.

診断を受けたのが22週、カイザーが30週であるからこの8週間（二ヶ月）妊婦とその夫ははどんな思いで過ごしたのだろう？？ 子宮壁はすでに裂けているのである。

無事出産し6ヶ月検診では元気なのだろう。

Uterine Rupture with Protruded Legs in a Large Amniocele

Pierre-Emmanuel Bouet, M.D., and Charlyne Herondelle, M.D.

N Engl J Med 2016; 375:e51December 22, 2016

Pierre-Emmanuel Bouet, M.D.
Charlyne Herondelle, M.D.
Centre Hospitalier Universitaire d’Angers, Angers, France