17例完全型子宫破裂临床分析

Clinical analysis of 17 cases of complete uterine rupture

目的探讨完全型子宫破裂的临床特点、治疗情况及母儿预后.方法回顾性分析2013年1月至2020年12月上海市第一妇婴保健院收治的17例完全型子宫破裂的病例资料.结果17例完全型子宫破裂均合并子宫瘢痕,其中剖宫产后阴道分娩(vaginal birth after cesarean section,VBAC)5例(29.4%),输卵管间质部妊娠术后5例(29.4%),腹腔镜子宫肌瘤或腺肌瘤术后4例(23.5%),输卵管壶腹部妊娠术后1例(5.9%),腹腔镜宫颈环扎术后1例(5.9%),宫腔镜宫腔粘连分解术后1例(5.9%).子宫破裂的平均孕周为36^(+3)周(28^(+2)~40^(+3)周),平均出血量1537.3 mL(300~3600 mL).胎死宫内3例,新生儿窒息4例.所有病例均行破裂修补术,无孕产妇死亡及子宫切除病例.结论妊娠合并子宫瘢痕为完全型子宫破裂的首要原因,快速识别子宫破裂是救治的关键.

Objective To investigate the clinical features,treatment and prognosis of complete uterine rupture.Methods The data of 17 cases of complete uterine rupture who were admitted to Shanghai First Maternity and Infant Hospital from January 2013 to December 2020 were retrospectively analyzed.Results The 17 cases of complete uterine rupture were all combined with uterine scars,including 5 cases(29.4%)of vaginal birth after cesarean section(VBAC),5 cases(29.4%)after tubal interstitial pregnancy,4 cases(23.5%)after endoscopic uterine fibroids or adenomyoma,1 case(5.9%)after tubal ampullary pregnancy,1 case(5.9%)after laparoscopic cervical cerclage,and 1 case(5.9%)underwent hysteroscopic intrauterine adhesions decomposition.The average gestational age of uterine rupture was 36^(+3) weeks(28^(+2)-40^(+3) weeks),and the average blood loss was 1537.3 mL(300~3600 mL).There were 3 cases of intrauterine stillbirth and 4 cases of neonatal asphyxia.All cases underwent rupture repair,and there were no cases of maternal death and hysterectomy.Conclusion Pregnancy with uterine scar is the primary cause of complete uterine rupture,and rapid identification of uterine rupture is the key to treatment.