疤痕子宫不全破裂30例分析

Incomplete rupture of scarred uterus apropos of 30 cases

目的探讨疤痕子宫不全破裂的原因及处理方法，提高剖宫产试产率。方法对我院2000年10月至2007年10月分娩的670例疤痕子宫、其中不全破裂30例进行回顾性分析。结果古典剖宫产疤痕子宫不全破裂11例（22．00％），新式剖宫产者19例（3．06％）；两次剖宫产疤痕子宫不全破裂16例（2．76％），单次剖宫产者14例（15．56％）；前次切口有感染致愈合不良者子宫不全破裂19例（27．14％），无感染者11例（1．83％）；前次手术距今时间〈2年者子宫不全破裂18例（22．5％），〉2年者12例（2．03％）疤痕子宫择期剖宫产发现子宫不全破裂22例（3．57％），经试产发现子宫不全破裂8例（9．09％）。结论古典式纵切口、重复子宫切口及两年以下切口、感染切口等为不牢固疤痕，容易破裂，疤痕子宫经严密筛选无禁忌症者可阴道试产，宫缩本身对牢固疤痕者影响与正常孕妇相似。疤痕子宫产妇产前应加强充分认识、积极准备、充分评估，如果没有再次剖宫产指征，应给予孕妇试产机会，部分产妇行阴道分娩是可行的。

Objective The purpose of our study was to identify the risk factors of incomplete rupture of scarred uterus during labour, to report maternal outcome, and to propose preventive measures. Methods Between october 2000 and october 2007, there were 670 cases of scarred uterus at our institution, 30 patients had Incomplete uterine rupture, Results Of these, incomplete rupture had happened during classical uterine-incision delivery was 22.00% and during new-style uterine-incision delivery was 3.06%. in the second uterine-incision delivery was 2.76% and in the fist uterine-incision delivery was 15.56%, with infected incision was 27.14% and no infected incision was 1.83% ,time between two operations 〈 2 years was 22.5% and 〉 2 years was 2.03%, caesarean section was 3.57% and attempts at vaginal delivery was 9.09%. Conchmion We recommend that all patients with a history of caesarean delivery should be delivered in hospital and observed closely for progression of labour, recognition of an active phase arrest requires operative delivery.We can select patients for attempts at vaginal delivery and they show that it is necessary to test the ability of the fetus to pass through the pelvis after looking very carefully at the partogram made for the previous caesarean operation.