25例妊娠子宫破裂临床分析

Clinical analysis of 25 cases of pregnancy uterine rupture

目的:探讨妊娠期子宫破裂的病因、临床表现、早期识别及诊断方法。方法:收集25例妊娠期子宫破裂患者的临床资料,对妊娠期子宫破裂的临床特点、孕期子宫下段瘢痕B超检查结果、产时胎心监护等进行分析。结果:25例妊娠期子宫破裂患者中,足月初产妇非瘢痕子宫破裂6例,经产妇瘢痕子宫破裂19例,其中中孕引产2例,足月分娩17例。5例瘢痕子宫阴道分娩出现胎监或听诊胎心异常。17例孕足月瘢痕子宫患者中10例进行了B超下子宫下段瘢痕厚度测量,其中9例子宫厚度与术中所见情况不一致。2例中孕引产患者为特殊手术子宫瘢痕破裂。结论:瘢痕子宫是引发妊娠期子宫破裂的主要原因。单次B超监测子宫瘢痕厚度不能有效预测子宫破裂;详细了解病史及既往手术情况、瘢痕子宫阴道分娩产时持续胎心监护、重视对瘢痕子宫中期妊娠引产产程监护有助于及时发现子宫破裂。

Objective:To investigate the clinical manifestations of uterine rupture during pregnancy and the method of prenatal identification,and find uterine rupture in time.Methods:the clinical data of 25 patients with uterine rupture during pregnancy were collected.The clinical characteristics of uterine rupture during pregnancy,the results of scar B in the lower segment of uterus during pregnancy and the monitoring of fetal heart during labor were analyzed.Results:In 25 cases of uterine rupture during pregnancy,there were 6 cases of full-term primipara without scar uterine rupture.There were 19 cases of uterine rupture with scar.Among them,2 cases are induction of labor in second trimester,17 cases are full term deliveries.5 cases are scar uterine vaginal delivery with abnormal fetal monitoring or auscultation.A total of 10 of 17 patients with full-term scar uterus underwent B measurement of scar thickness in the lower uterine segment.Among them,9 cases of uterine thickness were inconsistent with the intraoperative findings.In the 2 cases with induction of labor in second trimester,uterine scar rupture was a special operation.Conclusion:Scar uterus is the main cause of uterine rupture during pregnancy.A single B ultrasound monitoring of uterine scar thickness cannot effectively predict uterine rupture.A detailed understanding of the history and previous surgery,continuous fetal heart monitoring during vaginal delivery of scar uterus,and attention to monitoring the induced labor process of mid-term pregnancy of scar uterus are helpful to detect uterine rupture in time.