妊娠期子宫破裂12例临床分析

Clinical analysis of 12 cases of uterine rupture during pregnancy

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。

Objective To analyze the cause, clinical characteristics and preventive measui＇es of the uterine rupture during pregnancy. Methods Data of 12 patients diagnosed with uterine rupture from January 2006 to December 2011 in Peking University People＇s Hospital were retrospectively analyzed. Results The number of delivery in this period was 12 697, so the incidence of uterine rupture was 0. 09 % （12/12 697）. Clinical analysis found that 10 patients with uterine rupture were multipara with uterine scar after the prevous cesarean section, another patient was primipara with uterine scar after the previous myomectomy and primipara without special medical record. The clinical manifestations of uterine rupture varied in some degree, only 3 patients showed persistent abdominal pain or abdominal distension, 3 patients complained of irregular abdominal pain and the other patients had no obvious symptoms. Among the 12 patients, 10 incomplete uterine rupture were diagnosed during operation and 2 cases with com- plete rupture of uterus were diagnosed preoperatively. One patient had the history of infertility. Conclusion Uterine scar has become the most common cause of uterine rupture, efforts should be made to control the rate of cesarean section in primiparas and constantly improve the ability of diagnosis and treatment of uterine rupture in high - risk patients.