妊娠完全性子宫破裂9例临床分析

目的 探讨妊娠完全性子宫破裂的高危因素、临床特点及预后.方法 回顾性分析2014年1月至2017年4月沈阳市妇婴医院收治的9例妊娠完全性子宫破裂患者的临床资料,对患者的年龄、孕产史、孕周、既往手术史、此次妊娠距手术间隔时间、子宫破裂的位置、临床处理及母婴结局进行归纳总结.结果 9例妊娠合并完全性子宫破裂患者中,剖宫产术后瘢痕子宫前次剖宫产切口破裂3例(1例剖宫产切口妊娠并子宫破裂,2例为剖宫产术后瘢痕子宫中期引产)、腹腔镜子宫肌瘤术后瘢痕子宫2例、剖宫产合并腹腔镜输卵管手术后妊娠1例,腹腔镜输卵管手术后妊娠1例,双子宫1例,原因不明1例(有刮宫术病史).表现为持续性下腹痛7例,无典型子宫破裂的临床表现2例.9例均行子宫修补术,产后出血5例,输红细胞4例,无产妇死亡;1例胎死宫内,4例新生儿结局良好,3例为引产及剖宫产切口妊娠,1例新生儿窒息后死亡.结论 剖宫产史再次妊娠有子宫破裂的风险,应将所有曾接受子宫体部、输卵管手术的患者、子宫畸形、胎盘植入、多次孕产史的无子宫瘢痕孕妇视为发生子宫破裂的高危人群,以便早期识别和处理子宫破裂.

Clinical analysis of 9 cases of complete uterine rupture during pregnancy

Objective To analyze the cause,clinical characteristics and preventive measures of uterine rupture during pregnancy.Methods A retrospective analysis was performed on 9 case of complete uterine rupture during pregnancy from January 2014 to April 2017 in Shenyang Women's and Children's Hospital.Common causes and clinical features were summarized.Results Among the 9 patients with complete uterine rupture during pregnancy, 3 patients had uterine scar following previous cesarean section(1 patient due to ectopic pregnancy, 2 patients due to mid-late pregnancy termination for deformed fetus), 2 patients had uterine scar following previous laparoscopic myomectomy, 1 patient had uterine scar after cesarean section and following laparoscopic salpingectomy, 1 patient had uterine scar following laparoscopic fallopian tube, 1 patient had double uterus, and 1 patient had a history of curettage.The clinical manifestations of uterine rupture varied: 7 cases showed persistent abdominal pain or abdominal distension, whereas 2 cases had no obvious symptoms.All patients underwent uterine repair and survived, including 5 cases of postpartum hemorrhage and 4 cases of red blood cell transfusion.One fetus died in the uterus.The neonatal outcome was good in 4 patients.Three patients had cesarean section incision pregnancy.One newborn died of severe asphyxia.Conclusion We should pay attention to not only the patients with uterine scar following previous cesarean section but also all patients with a previous history of uterine surgery, uterine malformations, placenta accreta, and multiple pregnancy history without uterus scar, due to the risk of uterine rupture throughout the entire pregnancy.It enables early identification and treatment of uterine rupture.