完全性子宫破裂危险因素、母婴结局的研究

Study on risk factors and maternal and infant outcomes of complete uterine rupture

目的探讨完全性子宫破裂的发病现状、危险因素、临床特点及母婴结局。方法回顾性分析2010年5月至2020年5月华中科技大学附属同济医院收治的37例完全性子宫破裂患者的临床资料,依据是否有子宫瘢痕分为瘢痕子宫组(n=27)和非瘢痕子宫组(n=10)。比较两组基线资料、破裂部位、临床表现及母婴结局。结果妊娠中晚期完全性子宫破裂发生率为0.056%,其中产前子宫破裂发生率为0.041%,产时子宫破裂发生率为0.015%。瘢痕子宫孕产妇完全性子宫破裂发生率为0.344%,其中产前破裂、产时破裂占比分别为0.255%和0.089%;非瘢痕子宫孕产妇完全性子宫破裂发生率为0.017%,其中产前破裂和产时破裂占比分别为0.012%和0.005%。瘢痕子宫孕产妇完全性子宫破裂发生率显著高于非瘢痕子宫孕产妇,差异具有统计学意义(P<0.05);瘢痕子宫孕产妇产前和产时子宫破裂发生率与非瘢痕子宫孕产妇相比,差异无统计学差异(P>0.05)。两组子宫破裂部位比较,差异无统计学意义(P>0.05)。两组临床表现及妊娠结局比较,差异无统计学意义(P>0.05)。结论完全性子宫破裂对妊娠结局影响巨大,瘢痕子宫仍然是其主要危险因素,但也应重视胎盘植入、异位妊娠等引起非瘢痕子宫破裂的少见因素。

Objective To investigate the incidence,risk factors,clinical characteristics and maternal and infant outcomes of complete uterine rupture.Methods The clinical data of 37 patients with complete uterine rupture admitted to Tongji Hospital Affiliated to Huazhong University of Science and Technology from May 2010 to May 2020 were retrospectively analyzed.According to the presence or absence of uterine scar,they were divided into a scarred uterus group(n=27)and a non-scarred uterus group(n=10).Baseline data,rupture site,clinical manifestations and maternal and infant outcomes were compared between the two groups.Results The incidence of complete uterine rupture in the second and third trimester of pregnancy was 0.056%,among which the incidence of prenatal uterine rupture was 0.041%,and the incidence of intrapartum uterine rupture was 0.015%.The incidence of complete uterine rupture in women with scarred uterus was 0.344%,and the proportion of prenatal rupture and intrapartum rupture were 0.255%and 0.089%,respectively.The incidence of complete uterine rupture in women with non-scarred uterus was 0.017%,and the proportion of prenatal rupture and intrapartum rupture was 0.012%and 0.005%,respectively.The incidence of complete uterine rupture in pregnant women with scarred uterus was significantly higher than that in pregnant women with non-scarred uterus,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of uterine rupture between pregnant women with scarred uterus and those with non-scarred uterus before and during labor(P>0.05).There was no significant difference in uterine rupture site between the two groups(P>0.05).There was no significant difference in the most common clinical manifestations and pregnancy outcomes between the two groups(P>0.05).Conclusions Complete uterine rupture has a great impact on pregnancy outcome,and scarred uterus is still the main risk factor.However,attention should be paid to rare factors causing non-scar uterine rupture,such as placenta accreta and ectopic pregnancy.