剖宫产后再次妊娠子宫破裂20例临床分析

Clinical analysis of uterine rupture during pregnancy again after cesarean section:a study of 20 cases

目的:探讨我院剖宫产后再次妊娠子宫破裂的相关因素及预防措施。方法:对我院2003年1月至2010年12月收治的20例剖宫产后再次妊娠发生子宫破裂患者的临床病例进行回顾性分析。结果:本院同期共收治剖宫产后再次妊娠患者595例,有20例发生子宫瘢痕不同程度破裂,发生率为3.36%,13例患者发生完全子宫破裂,其中有2例还合并膀胱破裂,7例患者发生不完全性子宫破裂。20例患者中15例患者均为彝族女性,4例为汉族,1例为回族。完全性子宫破裂患者中有11例均为彝族女性,2例膀胱破裂患者均为彝族女性。围产儿死亡率为30%(6/20)。16例行子宫破裂修补术,4例行子宫次全切除术。结论:孕期管理系统不到位、患者对本身疾病的认识不够,民族之间的文化差异是导致我院剖宫产后再次妊娠子宫破裂的主要原因,加强孕期管理及宣教、普及生育知识、严格掌握初次剖宫产指征是预防剖宫产后再次妊娠子宫破裂、保障母婴安全的重要保障和有效途径。

Objective：To explore the relative factors and prevention measures of uterine rupture during pregnancy again after cesarean section.Methods：20 cases of uterine rupture during pregnancy again after cesarean section from January 2003 to December of 2010 were enrolled.The clinical data were analyzed retrospectively.Results：595 cases pregnancy again after cesarean section in the same period,20 cases of uterine rupture occurred in different degree,rate of 3.36%.Among the 20 cases,13 complete of 2 cases with bladder rupture and 7 incomplete uterine rupture.Among the 20 patients,15 Yi people,4 Han people and 1 Hui people.11 out of 13 cases with complete uterine rupture Yi people,including 2 cases with bladder rupture.Perinatal mortality was 30% （6/20）.16 uterine rupture were repaired,4 had sub-total hysterectomy.Conclusion：Disappointing pregnancy management system,deficient understanding of the disease and different national cultures were the primary causes of uterine rupture during pregnancy again after cesarean section.Strengthen the pregnancy management and mission,Popularize fertility knowledge and strictly controlled of surgical indication for cesarean section were prevention measures.