完全性子宫破裂的临床特点分析

Clinical characteristics of complete uterine rupture

目的探讨完全性子宫破裂的发病现状、危险因素、临床特点及其患者妊娠结局。方法选择2006年1月至2018年12月,在四川大学华西第二医院住院分娩的106 747例产妇为研究对象。采取回顾性分析法,分析完全性子宫破裂患者的患病率、一般临床资料、临床特征及妊娠结局等。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①本组患者的完全性子宫破裂患病率为0.038%(41/106 747),其中,2006-2015年为0.035%(26/73 369),2016-2018年为0.045%(15/33 378)。②41例完全性子宫破裂患者中,瘢痕子宫者为22例(53.7%),非瘢痕子宫者为19例(46.3%)。最常见的临床症状为持续性下腹部疼痛(48.7%,20/41),最常见临床体征为腹部及子宫压痛(58.5%,24/41),胎心异常仅为3例(15.0%,3/20)。③41例完全性子宫破裂患者中,无一例死亡,其中6例(14.6%)发生并发症;33例(80.5%)患者接受子宫修补术,7例(17.1%)接受全子宫切除术或者次全子宫切除术,1例(2.4%)因残角子宫妊娠接受残角子宫切除术。④41例完全性子宫破裂患者共计分娩活产新生儿为27例(61.0%),死胎为16例(39.0%)。27例活产新生儿中,转入新生儿科治疗为9例(33.3%),发生新生儿窒息为10例(37.0%),其中,轻度窒息为8例(29.6%),重度窒息为2例(7.40%);另外17例新生儿生后1 min Apgar评分均为良好。结论完全性子宫破裂患者最常见的危险因素包括瘢痕子宫、胎盘黏连及植入、宫腔镜手术史。若具有完全性子宫破裂高危因素的产妇出现持续性下腹部疼痛或者胎心异常,应警惕完全性子宫破裂的可能,及时手术治疗可改善母儿结局。

Objective To investigate the current status,clinical features and pregnancy outcome of complete uterine rupture in order to guide the clinical practice.Methods From January 2006 to December 2018,a total of 106747 parturients who gave birth in West China Second University Hospital,Sichuan University were selected into this study.The prevalence rate,general clinical data,clinical features and pregnancy outcomes of patients with complete uterine rupture were analyzed.This study was in line with the World Medical Association Declaration of Helsinki revised in 2013.Results①The prevalence rate of complete uterine rupture was 0.038%(41/106747),of which 0.035%(26/73369)in 2006-2015 and 0.045%(15/33378)in 2016-2018.②Among 41 patients with complete uterine rupture,22 patients(53.7%)had scar uterus and 19 patients(46.3%)had non-scar uterus.The most common clinical symptom was persistent lower abdominal pain(48.7%,20/41),the most common clinical signs was abdominal and uterine tenderness(58.5%,24/41),and fetal heart abnormalities was found in 15.0%(3/20)of patients.③All the mothers survived and 6 of them developed complications(14.6%).Hysterorrhaphy was performed in 33 cases(80.5%),total hysterectomy or subtotal hysterectomy was performed in 7 cases(17.1%),removal of rudimentary uterine horn was performed in 1 case(2.4%).④In 41 cases of complete rupture of uterus,27 cases(61.0%)were born alive and 16 cases(39.0%)were stillborn.Among 27 live births,9(33.3%)were transferred to pediatrics,10(37.0%)had neonatal asphyxia,8(29.6%)had mild asphyxia,2(7.40%)had severe asphyxia,and 17 had good Apgar scores(1 min after birth).Conclusions The most common risk factors of complete uterine rupture include scarred uterus,placental accreta and increta,history of hysteroscopic surgery.In pregnant women with high-risk factors of complete uterine rupture,persistent abdominal pain or abnormal fetal heart monitoring should be aware of the possibility of uterine rupture,and prompt surgical treatment can improve maternal and infant outcomes.