妊娠晚期及分娩期子宫破裂17例临床分析

Clinical analysis of 17 cases with uterine rupture during third trimester and delivery

目的:探讨妊娠晚期及分娩期子宫破裂的临床特征、诊治情况及母儿预后。方法:回顾分析2012年1月至2016年6月南方医科大学附属深圳市妇幼保健院收治的17例子宫破裂患者的临床特点、诊断、治疗及预后。结果:妊娠晚期子宫破裂10例,分娩期子宫破裂7例。17例均有子宫手术或异位妊娠手术史,其中子宫下段剖宫产11例,腹腔镜下子宫肌瘤剔除术1例,腹腔镜下异位妊娠手术5例(4例宫角切除术,1例2次输卵管切除术史)。患者合并产后出血5例,其中失血性休克2例,均行子宫破裂修补术,术后恢复良好。胎婴结局中发生死胎1例;新生儿重度窒息1例(新生儿期死亡);新生儿轻度窒息2例,均未发现神经系统后遗症;余13例新生儿预后良好。结论:瘢痕子宫再妊娠者,妊娠晚期出现持续性腹痛症状及分娩期出现胎心异常均应警惕子宫破裂可能。建立紧急剖宫产反应团队能有效改善母儿预后。

Objective： To study the clinical features,management,pregnancy outcomes of uterine rupture during third trimester and delivery.Methods： From Jan.2012 to Jun. 2016,17 cases of patients with uterine rupture were included in the study. Retrospective analysis was done in the clinical features,diagnosis,treatment and pregnancy outcomes. Results： There were10 cases of uterine rupture occurred at third trimester while 7 cases occurred at delivery.All patients of uterine rupture had history of uterine surgery or fallopian tube surgery,included 11 cases of caesarean section,1 case of laparoscopic hysteromyoma,and 5 cases of laparoscopic ectopic pregnancy.The patients of uterine rupture group all were done surgical repair of uterine,with5 cases of postpartum hemorrhage,and included 2 cases of hemorrhagic shock.There was 1 case of intrauterine fetal death,1 case of serious neonatal asphyxia,2 cases of mild neonatal asphyxia,the rest of 13 cases of neonatal prognosis was good.Conclusions： All pregnant women after uterine surgery should be carefully observed.Persistent abdominal pain symptoms in third trimester and fetal heart rate abnormality in the labor process should be aware of the possibility of uterine rupture.Establishing emergency cesarean section team is a effective ways of improving the pregnancy outcomes.