妊娠期完全性子宫破裂临床分析

Clinical analysis of complete uterine ruptrue during pregnancy

目的:探讨妊娠期完全性子宫破裂的发生率、高危因素、临床特点及妊娠结局。方法:以2010年1月—2019年12月本院收治的妊娠期完全性子宫破裂患者30例为研究对象,分析其临床特点、诊治过程及妊娠结局。结果:完全性子宫破裂发生率为0.017%(24/141 617),子宫破裂中位孕周37周(16~42周)。瘢痕子宫17例(56.7%),非瘢痕子宫13例(43.3%)。孕期发生子宫破裂10例(33.3%),产时发生20例(66.7%)。临床表现腹痛22例(73.3%),胎心异常17例(56.7%)。无一例孕产妇死亡,2例切除子宫。23例患者输血>1000ml 15例。与子宫破裂相关的围产儿死亡9例。与非瘢痕子宫发生子宫破裂比较,瘢痕子宫孕妇有更高产次(P<0.01)。结论:瘢痕子宫是完全性子宫破裂最主要高危因素,但其他原因也不少见。完全性子宫破裂可导致严重的不良妊娠结局。非瘢痕子宫破裂临床表现似乎更严重,大量输血率更高。

Objective: To analyze the incidence, high risk factors, clinical feature, and maternal and fetal outcomes of women with complete uterine ruptrue during pregnancy. Methods: This study retrospectively enrolled 30 pregnant women with complete uterine rupture during pregnancy from January 2010 to December 2019. The clinical feature, diagnosis and treatment process, and pregnancy outcomes of these women during pregnancy were analyzed. Results: There were 17(56.7%) women with scar uterus, and 13(43.3%) women without scar uterus. Uterine rupture occurred in 10(33.3%) women during pregnancy and in 20(66.7%) women during delivery. In these women, the clinical manifestations included 22(73.3%) women with abdominal pain, and 17(56.7%) fetus with abnormal heart. There was no any maternal death, and only 2 women had accepted hysterectomy. Among 23 women had given blood transfusion, there were 15 cases had received more than 1000 ml blood. There were 9 perinatal fetal deaths related to uterine rupture. Compared with that of women with no-scar uterine rupture, the times of delivery of women with scar uterine rupture was more(P<0.01). Conclusion: Scarred uterus is the main reason of uterine rupture, but other causes should not be ignored. Complete uterine rupture can lead to severe adverse pregnancy outcomes. The clinical manifestations of uterine rupture of women without scarred uterus seem to be more severe with higher rate of heavy transfusion.