剖宫产后再次妊娠并发子宫破裂的早期诊断

疤痕子宫在再次妊娠的晚期或分娩期易发生子宫破裂或子宫切口裂开 ,是再次妊娠灾难性的并发症之一 ,Guise等进行多样本的调查 ,查阅了 5 6 8篇论文 ,得出与选择性重复剖宫产比较 ,剖宫产后再次妊娠阴道试产过程中子宫破裂的危险增加2 .7‰ ,围生儿死亡增加 1.4‰ ,子宫切除增加 3.4‰的结果。导致疤痕子宫的主要原因是前次剖宫产 ,其次为妊娠子宫破裂或子宫穿孔后子宫修补术 ,子宫肌瘤挖出术 ,特别是子宫肌瘤较大 ,深达子宫内膜时 ,手术后在子宫肌层留下薄弱点 ,在再次妊娠时 ,尤其是在妊娠晚期 ,子宫容积增大 ,加上分娩期的子宫羊膜腔内压…     

瘢痕子宫再次妊娠致子宫破裂危险因素的临床研究

<正>子宫破裂系产科的急症,严重威胁母儿生命。随着近年剖宫产率的大幅提高,瘢痕子宫孕妇孕期及分娩期需面临子宫破裂的风险,其分娩方式的选择成为产科工作者棘手的问题。通过回顾分析我院2002年~2010年收治的32例子宫破裂患者的临床资料,探讨子宫破裂发生的危险因素、尤其是剖宫产后瘢痕子宫发生子宫破裂的危险因素,指导临床对子宫破裂的认识、诊断及积极防治,避免母儿的不良结局。1资料与方法1.1一般资料2002年至2010年在我院分娩的产妇中行剖宫产者35446例,其中瘢痕子宫4191例;经阴道分娩者     

子宫破裂的常见原因及预防

子宫破裂是一种严重威胁母儿生命安全的围产期并发症。随着生育政策的开放,国内孕产妇子宫破裂的发生率有上升趋势,主要原因是瘢痕子宫。瘢痕子宫的成因除剖宫产外,还有非产科因素的子宫手术史,后者也是最容易被忽视的病因。瘢痕子宫的子宫破裂多在阴道分娩过程中发生,但胎盘植入可导致妊娠中晚期的自发子宫破裂,值得临床关注。腹痛、阴道流血和胎心下降是子宫破裂常见的临床表现,妊娠中晚期隐匿性的子宫破裂则常以腹痛和休克症状为临床表现。因此,子宫破裂的早期识别和及时手术治疗与母儿结局息息相关。文章着重阐述了子宫破裂的常见原因及临床表现,以期提高临床医生的警惕性,改善此类孕产妇的母儿结局。     

子宫破裂的病因及预防

子宫破裂实际指妊娠子宫的破裂,多发生在妊娠中,晚期及分娩期。关于子宫破裂的病因,许多文献资料认为属机械性,即头盆不称引起分娩受阻,出现过强子宫收缩,导致病理性子宫收缩环,结局为发生子宫破裂。根据近几年的研究,子宫破裂不只是这种原因,大致有以下几方面的原因。1.机械性(高张性)子宫破裂此种破裂可发生在妊娠中期或晚期引产过程中,或狭窄骨盆自然分娩过程中。发生的病因是子宫收缩过强发展到强直性子宫收缩,形成病理性子宫收缩环,子宫下段肌肉被拉长变成菲薄,在外因的刺激下而破裂。常见的外因有两种:     

实时超声造影技术诊断中期妊娠子宫破裂二例报告及临床分析

随着剖宫产率的升高,瘢痕子宫妊娠破裂的发生率也越来越高,且多发生于分娩期和妊娠末期[1].由于子宫破裂的发生常危及患者生命,分娩期和妊娠末期的子宫破裂易被关注,而中期妊娠子宫破裂发生率低,妇产科临床医师和超声医师容易忽视和漏诊,此外,超声检查对完全性子宫破裂,胎儿破入腹腔的病例诊断正确率高,但对中期妊娠不完全子宫破裂容易漏诊或误诊,导致延误抢救的最佳时机[2],增加孕产妇死亡率.     

分娩期子宫破裂并发膀胱破裂1例报告

目的：探讨子宫破裂并发膀胱破裂的原因,提高对瘢痕子宫孕妇发生子宫破裂及周围脏器破裂的警惕性。方法：回顾性分析2013年1月我院收治的一例子宫破裂并发膀胱破裂孕妇临床资料。结果：本例瘢痕子宫孕妇经阴道分娩过程中发生子宫破裂并发膀胱破裂,行子宫修补加膀胱修补术。结论：子宫破裂及膀胱等周围脏器破裂为产科严重并发症,尤其对于瘢痕子宫孕妇经阴道分娩者应给予高度重视。     

妊娠晚期及分娩期子宫破裂17例临床分析

目的:探讨妊娠晚期及分娩期子宫破裂的临床特征、诊治情况及母儿预后。方法:回顾分析2012年1月至2016年6月南方医科大学附属深圳市妇幼保健院收治的17例子宫破裂患者的临床特点、诊断、治疗及预后。结果:妊娠晚期子宫破裂10例,分娩期子宫破裂7例。17例均有子宫手术或异位妊娠手术史,其中子宫下段剖宫产11例,腹腔镜下子宫肌瘤剔除术1例,腹腔镜下异位妊娠手术5例(4例宫角切除术,1例2次输卵管切除术史)。患者合并产后出血5例,其中失血性休克2例,均行子宫破裂修补术,术后恢复良好。胎婴结局中发生死胎1例;新生儿重度窒息1例(新生儿期死亡);新生儿轻度窒息2例,均未发现神经系统后遗症;余13例新生儿预后良好。结论:瘢痕子宫再妊娠者,妊娠晚期出现持续性腹痛症状及分娩期出现胎心异常均应警惕子宫破裂可能。建立紧急剖宫产反应团队能有效改善母儿预后。     

特殊部位异位妊娠

1　残角子宫妊娠 (ｒｕｄｉｍｅｎｔａｒｙｈｏｒｎｐｒｅｇｎａｎｃｙ)　　是指受精卵着床和发育于残角子宫的一种异位妊娠。其主要症状包括停经、下腹部胀痛和不规则阴道出血 ,妇科检查时在正常或稍大的子宫旁可扪及略小于停经月份妊娠子宫的质地较软的包块。残角子宫妊娠大多在妊娠早期即发生妊娠中断 ,而有类似流产的不规则阴道流血症状。有的病例在妊娠中期会发生子宫破裂 ,出现严重的腹腔内出血。个别未发生破裂者可进展到妊娠晚期 ,此时可表现有胎位不正及胎儿先露部高浮等异常情况 ,并于妊娠足月时可出现宫缩 ,但宫颈管不见消失 ,子…     

妊娠期子宫破裂高危因素的研究进展

子宫破裂是一种产科严重并发症，其发生率较低，但对产妇及围生儿结局影响较大。子宫破裂由多种因素共同导致，其中最常见的高危因素是由剖宫产及子宫相关手术导致的瘢痕子宫。随着我国二胎政策的放开，原瘢痕子宫再次妊娠，子宫破裂潜在风险增加。此外，非瘢痕子宫破裂的危险因素包括子宫畸形、难产、孕妇年龄、孕次、产次以及药物等，因其受孕妇个人、家庭支持及社会背景等因素影响，故不容忽视。相比分娩期的子宫破裂，妊娠期子宫破裂并发症更为严重，需医务工作者高度重视。现综述妊娠期子宫破裂的影响因素，并对妊娠期子宫破裂的筛查评估提出建议，旨在预防妊娠期子宫破裂，为早发现、早诊断并及时采取措施，避免对母胎造成更严重的伤害提供依据。     

妊娠期子宫破裂高危因素的研究进展

子宫破裂是一种产科严重并发症,其发生率较低,但对产妇及围生儿结局影响较大。子宫破裂由多种因素共同导致,其中最常见的高危因素是由剖宫产及子宫相关手术导致的瘢痕子宫。随着我国二胎政策的放开,原瘢痕子宫再次妊娠,子宫破裂潜在风险增加。此外,非瘢痕子宫破裂的危险因素包括子宫畸形、难产、孕妇年龄、孕次、产次以及药物等,因其受孕妇个人、家庭支持及社会背景等因素影响,故不容忽视。相比分娩期的子宫破裂,妊娠期子宫破裂并发症更为严重,需医务工作者高度重视。现综述妊娠期子宫破裂的影响因素,并对妊娠期子宫破裂的筛查评估提出建议,旨在预防妊娠期子宫破裂,为早发现、早诊断并及时采取措施,避免对母胎造成更严重的伤害提供依据。     

"Silent" rupture of unscarred gravid uterus with subsequent pelvic abscess: successful laparoscopic management

Intrapartum rupture of an unscarred uterus is rare in current times. However, it is still associated with significant maternal and fetal mortality and morbidity. Unlike rupture or dehiscence of a previous cesarean scar, which is occasionally bloodless, complete rupture of a gravid unscarred uterus frequently results in fetal jeopardy and significant maternal intraperitoneal bleeding, causes acute abdomen, and demands emergency surgical (laparotomy) intervention. Laparoscopy generally has no role in such circumstances due to the generally unstable maternal hemodynamic condition and the necessity of prompt fetal delivery with an abdominal approach. We present a rare case of intrapartum rupture of an unscarred gravid uterus with an atypical insidious clinical course. The diagnosis of complete uterine rupture was made 20 days after the patient's successful vaginal delivery, at which time a large pelvic abscess formed. The condition was successfully managed laparoscopically. Successful vaginal delivery, even with normal lochia, good uterine contraction, and stable vital signs, does not preclude the possibility of uterine rupture. For patients with unusual postpartum pelvic pain, uterine rupture should be considered as one of the possible etiologic factors, and prompt survey should be performed. Laparoscopic intervention may be valuable in such situations.     

A case of uterine rupture discovered in the postpartum period

Because of the increasing number of cicatricial uteruses, uterine ruptures are likely to become more frequent. However, few cases discovered in the postpartum period are described in literature. Our case report describes a uterine rupture, which occurred during a quick vaginal delivery, in a patient with previous cesarian section. The diagnosis has been made few days after delivery, the patient presenting pelvic pain and fever. We do not disagree with the principle to check uterine scar only when suspicion of rupture, but we should keep in mind that in case of endometritis in the postpartum period, with cicatricial uterus, it would be necessary to research uterine rupture by fitted imaging.     

Previous preterm cesarean delivery: identification of a new risk factor for uterine rupture in VBAC candidates.

OBJECTIVE: A major risk of trials of labor in patients with prior cesarean delivery is uterine rupture. We evaluated the question of whether a previous cesarean delivery at an early gestational age predisposes the patient to subsequent uterine rupture. METHODS: This was a retrospective chart review of patients delivering at North Shore University Hospital with a trial of labor after previous cesarean delivery to ascertain all cases of uterine rupture. Patients who had had a previous cesarean delivery at our institution who did not suffer uterine rupture during a trial of labor served as controls. RESULTS: Twenty-five patients suffered a uterine rupture. The incidence of prior preterm cesarean delivery (PPCD) in this group was 40%, compared to 10.9% of 691 laboring vaginal birth after cesarean (VBAC) patients without rupture (p < 0.001). Patients in the rupture group with a PPCD were less likely to have experienced labor in the index pregnancy and more likely to have had an interdelivery interval of less than two years. CONCLUSIONS: An undeveloped lower segment in the preterm uterus represents a risk for later rupture, even if the incision is transverse.     

妊娠期子宫破裂8例报告及文献复习

目的:探讨妊娠期子宫破裂的可能原因、临床表现及预防措施。方法:回顾2013—2016年首都医科大学附属北京安贞医院妇产科收治的8例子宫破裂患者的临床特点、治疗情况及预后,并结合相关文献进行分析。结果:8例妊娠期子宫破裂患者中有7例是瘢痕子宫破裂,1例是非瘢痕子宫破裂,临床表现多样。妊娠期瘢痕子宫发生破裂的概率较非瘢痕子宫高,而剖宫产术是造成瘢痕子宫及再次妊娠子宫破裂的高危因素。结论:剖宫产术后再次妊娠的时机及分娩方式的选择对预防妊娠期子宫破裂的发生至关重要。     

Rupture of the primigravid uterus: a review of the literature

Uterine rupture is a catastrophic obstetric complication, associated with high rates of perinatal morbidity and mortality. The most common risk factor is previous uterine surgery, and most cases of uterine rupture occur in women with a previous cesarean delivery. Traditionally, the primigravid uterus has been considered almost immune to spontaneous rupture. In fact, although spontaneous rupture of the primigravid uterus is indeed a very rare event, a number of such cases have been reported recently. Prompt recognition of uterine rupture and expeditious recourse to laparotomy are critical in influencing perinatal and maternal morbidity. Not all uterine ruptures present with the typical clinical picture of abdominal pain, hypovolemia, vaginal bleeding, and fetal compromise. Therefore, it is important to maintain a high index of suspicion for uterine rupture in women presenting with some, or all, of these features, regardless of parity. Here we provide a systematic review of cases of spontaneous uterine rupture in primigravid women reported in the literature to date. Clinical presentation, differential diagnosis, common etiological factors, complication rates, and appropriate management of this rare obstetric event are discussed. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall that uterine rupture in a primigravida is a rare event, without typical signs and symptoms, and explain that the morbidity and mortality of the mother and child is directly related to a high index of suspicion and prompt treatment by the clinician.     

Dystocia among women with symptomatic uterine rupture

OBJECTIVE: The purpose of this study was to analyze cervical dilatation patterns among women with uterine rupture by means of a mathematic model and to use the results to determine optimal intervention criteria. STUDY DESIGN: This was a case-control review that compared a case patient group of 19 women with uterine rupture during labor with control groups with either no previous cesarean deliveries, vaginal birth after cesarean delivery, or failure of attempted vaginal birth after cesarean delivery. The mathematic model quantified dilatation and adjusted for conditions specific to each patient. Case patients were compared with matched control subjects by means of paired t tests, analysis of variance, odds ratios, and conditional logistic regression. RESULTS: Dystocia was present in 31.6% to 47.4% of patients with uterine rupture, versus 2.6% to 13.2% of the control group with no previous cesarean deliveries (P< or =.001). The incidence of an arrest disorder among patients with uterine rupture was similar to that seen in the control group with failure of attempted vaginal birth after cesarean delivery. However, the interval from diagnosis to rupture or cesarean delivery was 5.5 +/- 3.3 hours among case patients with uterine rupture and 1.5 +/- 1.3 hours in the control group with failure of attempted vaginal birth after cesarean delivery. CONCLUSION: When cervical dilatation was lower than the 10th percentile and was arrested for > or =2 hours, cesarean delivery would have prevented 42.1% of the cases of uterine rupture and resulted in excess 2.6% and 7.9% cesarean delivery rates among women with no previous cesarean deliveries and women with vaginal birth after cesarean delivery, respectively.     

MRI features and differential diagnoses of congenital vaginal atresia

Objective: To investigate the MRI manifestations of congenital vaginal atresia, analyze its imaging features, and improve the understanding of the disease.

Methods: MRI findings and clinical data of 12 patients with congenital vaginal atresia confirmed by hysteroscopy and laparoscopic surgery were retrospectively analyzed. Vaginal atresia was classified according to vaginal dysplasia in AFS female genital malformation classification system.

Results: In this study, 12 cases of congenital vaginal atresia were diagnosed by combined preoperative MRI with operative diagnosis. Among them, 10 patients all had type-I congenital vaginal atresia, and their uterus and cervix were normal (1 patient had ectopic renal malformation combined with left ovarian endometriosis cyst and 1 patient with uterine empyema). The other two cases were diagnosed congenital vaginal atresia type II (1 case merged with residual uterus, 1 case with cervical dysplasia). MRI mainly manifested as dilatation and hemorrhage in the uterine cavity, cervical canal and vaginal upper segment. T1WI showed high signal, T2WI showed slightly lower and slightly higher signal. The dilated vagina was above the perineal level.

Conclusion: MRI features of congenital vaginal atresia have certain characteristics. MRI cannot only accurately assess the type of vaginal dysplasia and its associated complications, but also make objective evaluation and diagnosis, so it can be used as the best effective preoperative image evaluation.     

妊娠期子宫破裂12例临床分析

目的探讨妊娠期子宫破裂的原因、临床特点及预防措施。方法对2006年1月至2011年12月北京大学人民医院妇产科收治的12例妊娠期子宫破裂的临床资料进行回顾性分析。结果子宫破裂的发生率为0.09%(12/12697)。12例患者中,10例经产妇为剖宫产术后瘢痕子宫妊娠,1例初产妇为子宫肌瘤切除术后瘢痕子宫妊娠,1例初产妇无特殊病史;子宫破裂的临床表现不一,3例患者表现为持续性腹痛,3例患者表现为不规律下腹痛,1例合并不孕病史,其他患者无明显症状;其中10例子宫破裂为不全子宫破裂且为术中诊断,2例为完全子宫破裂,术前经B超诊断。结论瘢痕子宫是子宫破裂最常见的原因,应努力控制初产妇的剖宫产率,并提高诊治子宫破裂高危患者的能力。