分娩期子宫破裂20例临床诊治体会

目的 探讨子宫破裂的病因、诊断治疗及预防措施，减少孕产妇及围产儿死亡。方法回顾性分析2002年至2008年蓬安县人民医院收治的20例分娩期子宫破裂患者的临床资料。结果不全性子宫破裂8例，完全性子宫破裂12例；导致子宫破裂的病因中，瘢痕性子宫11例，梗阻性难产3例，产前不当使用宫缩剂1例，多次生产5例；死胎8例，死产6例，围产儿死亡率为70％（14／20）；9例行子宫破裂修补术，9例行子宫次全切除术，2例行子宫全切术。结论加强产前检查，密切观察产程，避免忽略性难产的发生。瘢痕子宫及多次生产者，应提前住院待产，若无梗阻性难产存在，可在严密观察下经阴道试产。对缩宫素、前列腺素等子宫收缩剂的使用指征、方法应严格掌握，避免滥用。严格掌握剖宫产及各种阴道手术指征。

Diagnosis and treatment of uterine rupture in delivery

Objective To investigate the cause and clinical feature of uterine rupture in order to reduce maternal and perinatal mortality. Methods 20 uterine rupture in delivery cases from 2002 to 2008 were enrolled. The clinical data were analyzed retrospectively. Results Among the 20 cases, 8 incomplete and 12 complete uterine rupture; causes of uterine rupture were uterine scar in 11 cases, obstructive dystocia in 3 cases, improper use of prenatal uterine agent in 1 case, multiple pregnancy in 5 cases. There were 8 fetal death and 6 cases of stillbirth, perinatal mortality of 70% （14/20）. 9 uterine rupture were repaired, 9 had sub - total hysterectomy, and 2 had total hysterectomy. Conclusion Prenatal care should be strengthed and labor process should be carefully monitored to avoid neglected dystocia. Pregnant women with cesarean section or uterine incision history and muhipara women should be hospitalized in advance, and carefully be chosen the delivery way. Transvaginal delivery can be tried in the absence of obstructive dystocia under close monitoring. Oxytocin, prostaglandin and other agents used to promote uterine contraction should be used with strict surveillance to prevent abuse. Surgical indication should be strictly controlled for cesarean section and vaginal surgery.