妊娠子宫破裂19例临床分析

Clinical analysis of 19 patients with uterine rupture during pregnancy

目的分析妊娠时子宫发生破裂的病因,总结临床发病特征及治疗经验。方法回顾分析2011年4月至2020年3月在北京大学第三医院住院分娩的19例子宫破裂患者的诊疗过程。结果19例患者中,瘢痕子宫18例,占94.74%,另外1例患者无明确相关病史,占5.26%。19例患者中,完全子宫破裂者15例,占78.95%,不完全子宫破裂者4例,占21.05%。15例完全子宫破裂患者中,7例以下腹疼痛为首发症状,3例以阴道出血为首发症状,其余5例无典型子宫破裂表现。不完全子宫破裂患者和完全子宫破裂患者中均有1例围产儿死亡,另外,完全子宫破裂患者中有1例新生儿重度窒息。结论妊娠子宫破裂常见于瘢痕子宫,应加强监测,当瘢痕子宫妊娠期出现下腹痛及产时监护出现胎心异常应警惕子宫破裂。

Objective To analyze the etiology of uterine rupture during pregnancy,and to summarize the clinical characteristics and treatment experience.Methods A retrospective analysis of the treatment of 19 patients with uterine rupture was conducted who were hospitalized and delivered in Peking University Third Hospital from April 2011 to March 2020.Results Among the 19 patients,18 patients(94.74%)had scarred uterine,one patient(5.26%)had no obvious risk factor.Of the 19 patients,15(78.95%)had complete uterine rupture and 4(21.05%)had incomplete uterine rupture.Among 15 patients with complete uterine rupture,7 patients complained that the first symptom was lower abdominal pain,3 patients was vagina bleeding,the rest patients had no typical presentation.There was one patient both in the patients with complete uterine and in patients with incomplete uterine suffered from fetal death,respectively.At the same time,there was one newborn with severe asphyxia among complete uterine patients.Conclusion Scarred uterine is common in uterine rupture during pregnancy.Hence,more attention should be paid to the pregnant women with a history of uterus scar,especially,when they have a lower abdominal pain and are abnormal during intrapartum fetal heart monitoring,the uterine rupture should be considered.