边远地区子宫破裂发生的原因及预防

Causes and Prevention of the Uterus Repture in an Outlying District of Hunan Province

目的 探讨边远地区子宫破裂发生的原因及预防措施。方法 回顾性分析湖南省永顺县医院妇产科 12年住院病例中 17例子宫破裂的病历资料。结果 17例子宫破裂中 ,平均每人产前检查次数 0 4次 ,平均出血量 110 0ml ,发生休克 12例( 70 6%) ,子宫切除 5例 ( 2 9 4%) ,围产儿死亡 16例 ( 94%)。根据破裂发生的时间分 :⑴产时破裂 15例 ( 88 2 4%) ,均无入院待产 ,平均临产时间 2 9.4h ,经产妇 12例 ( 80 %) ,初产妇 3例 ( 2 0 %) ,家庭中分娩 13例 ( 86 7%) ,医院中分娩 2例 ( 2 3 3 %) ,胎位异常 14例( 93 3 %)。⑵孕期自发性破裂 2例 ( 11 7%) ,均有宫体部剖宫产手术史 ,前次手术在乡以下医疗单位实施。结论 边远地区子宫破裂发生的原因 :⑴忽视孕期检查。⑵产时破裂的主要原因是家庭分娩 ,使异常的分娩得不到及时的处理 ;其次是滞产产妇的处理不当。⑶孕期自发破裂的主要原因为前次宫体部剖宫产术。预防工作应从加强孕期检查、强化住院分娩和规范施术单位着手 ,建立适宜于边远地区的孕期检查系统。

Objective To study the causes of the uterus rupture in an outlying district and prevent measures.Methods 17 cases of the uterus rupture in Yongshun county hospital were retrospectively analysized.Results Among 17 cases of uterus rupture,the average antenatal care was 0 4 times every pregnant women,bleeding volume were 1100 ml,12 cases of shock(70 6%) ,5 cases forced uterectomy(29 4%), 16 cases of perinatal death(94%). According to stages of taking place : ⑴15 cases had taken place during laboring without appointing inpatient ,13 patients giving birth at home while 2 patients in hospital , average total stages of labor 29.4h, abnormal fetal positions 14 cases, including 3 cases of primipara and 12 cases of multipara. ⑵ 2 cases of spontaneous uterus rupture occurred during pregnancy who have with the cesarean section history performed in small clinic in the country side.Conclusions In an outlying district, main causes of uterus rupture:⑴ Ignored antenatal care. ⑵ Producing at home so that dystocia were not dealt with properly during stage of labor, another was women with prolong labor treated incorrectly . ⑶ The Spontaneous rupture during pregnancy were close related to the history of the classical cesarean section .To prevent the uterus rupture should be enhanced prenatal care and examination forced pregnant women delivery in hospital, standarding medical practice of performing operation, so doing could sharply decrease the pregnant uterus rupture in an outlying district.