Non-Laboring Uterine Rupture of an Unscared Uterus before Term Discover during Obstetric Ultrasound

Uterine rupture is defined as the occurrence of communication between the abdominal and uterine cavity and may be complete or incomplete depending on the degree of involvement of the different layers of the uterus and surrounding organs. It is a rare complication whose consequences often involve the maternal and fetal prognosis. The majority of uterine rupture occurs on the scarred uterus, its incidence in France is estimated according to the series between 1/1000 and 1/2000 births, it represents 30% of causes of maternal death in the developing countries. The authors report here a case of uterine rupture outside of labor at 33 weeks of age in 32 years old woman, gravida 9 para 8, with no history of uterine surgery discovered during obstetric ultrasound for abdominal pain. During the interrogation, she was alarge multipara and had a child of 15 months. The abdominal ultrasound showed a right lateral corporeal rupture with hemoperitoneum of medium sized and a dead fetus. The emergency laparotomy revealed a right lateral uterine wound approximately 15 cm long with intra-abdominal placenta and a haemoperitoneum of medium sized of about 600 cc and a bladder lesion. After opening the amniotic sac, there was extraction of a dead fetus. The uterine and bladder lesions were repaired followed by bilateral tubal ligation. The patient received 500 cc of whole blood during and 500 cc after the procedure. The postoperative follow-up was simple. This case contributes to the knowledge of this rare and atypical event, and emphasizes the importance of maintaining a suspicion.

Rupture of a Rudimentary Uterine Horn: A Case Report

Pregnancy in an abnormal uterus is a high-risk situation in obstetrics. Uterus bicornis unicollis with a rudimentary horn is often discovered incidentally. The aim of this report is to warn obstetricians about recurrent abdominal pain in the second trimester of pregnancy without any cause identified. Pregnancy can proceed in the rudimentary horn. We presented a case of a rupture of the rudimentary horn which occurred at 25 weeks of amenorrhea in an unmarried 19-year-old primigravida. The rudimentary horn was removed after performing an emergency laparotomy for an intraperitoneal hemorrhage with signs of shock. This abnormality is often revealed by uterine rupture, which usually occurs in the second trimester of pregnancy. Conclusion: We emphasize the importance of early diagnosis of this uterine abnormality, before pregnancy if possible. Undiagnosed, this condition evolves towards uterine rupture during pregnancy and requires emergency surgery with excision of the rudimentary horn.

The perplexing entity of rudimentary uterine horn

A rudimentary uterine horn may be responsible for intriguing presentations in different stages of life. These presentations often masquerade commoner gynaecologic disorders resulting in diagnostic and management challenges for the treating clinicians. Whereas many of these anomalies may be discovered during the investigative workup for cryptomenorrhoea, dysmenorrhoea and infertility, lack of symptoms especially in a parous woman, a large proportion remains undiagnosed. We report here, two interesting presentations of this benign entity resulting in significant morbidity. The first case report describes late activation of a rudimentary horn presenting as chronic pelvic pain. The second patient presented with a failed second trimester induction of labor (abortion) for fetal demise. Her examination and investigations suggested an abdominal pregnancy, yet, on laparotomy, a 15 week pregnancy within an accessory uterine horn was discovered.

First Trimester Uterine Rupture: A Case Report on a Patient with Unsuspected Müllerian Duct Anomaly

Introduction: Mullerian malformations are a group of malformations that result from an alteration of embryonic development. Most cases are asymptomatic, however, in pregnant patients it has been associated with recurrent abortion or premature delivery. Case presentation: 12 + 2 weeks pregnant woman consulted for abdominal pain, vomiting and fever. During the study, a transvaginal ultrasound was performed, where two endometric cavities and a pregnancy in the right horn were observed. The evolution of the patient was torpid, reaching hypovolemic shock, resolved by an emergency laparotomy where the rupture of the right horn was found. Discussion: The bicornuate uterus is the consequence of a partial fusion of the paramesonephric ducts during the fetal development, resulting in two functional uterine horns. Patients with bicornuate uterus may be asymptomatic, a uterine rupture is a rare but potentially severe complication of the bicornuate uterus and is usually presented during first and second trimester. Conclusions: Pregnancy with Mullerian anomalies often has preterm delivery, IUGR and malpresentation, and even more severe complication as uterine ruptura, so, requires proper counselling and close monitoring during antenatal period.

Complete Rupture of the Pregnant Uterus:A 10-year Retrospective Descriptive Study

Objective:The goal of this work is to analyze the incidence,etiology,clinical characteristics,maternal and neonatal outcomes of complete uterine rupture during pregnancy.Methods:The information of complete uterine rupture between June 2010 and May 2020 was investigated retrospectively at a tertiary center,and included demographic data,delivery characteristics,intraoperative findings,and maternal and neonatal outcomes.The prevalence rate of uterine rupture in the early group(hospitalized from June 2010 to May 2015)and late group(June 2015 to May 2020)was compared and analyzed.

Third-Trimester Spontaneous Uterine Rupture After Ultrasound-Guided High-Intensity Focused Ultrasound Therapy

To editor:Uterine rupture,despite its low incidence,is a severe obstetric complication that is associated with adverse maternal and neonatal outcomes.Previous uterine scarring is a known risk factor for uterine rupture.Uterine scars can form from hysterotomy after abdominal/hysteroscopic myomectomy,cesarean delivery,or hysteroscopic surgery.Over the past few decades,ultrasound-guided high-intensity focused ultrasound(USgHIFU)has emerged as a non-invasive therapeutic tool and has found wide application for the safe and effective management strategy of uterine fibroids and adenomyosis.

妊娠期子宫破裂预警风险评估工具的构建及信效度检验

目的:构建适用于我国的妊娠期子宫破裂预警风险评估工具并检验其信效度。方法:通过查阅文献、病例分析和小组讨论,初步拟定风险评估指标体系条目池,采用德尔菲专家咨询法和预调查,形成最终的妊娠期子宫破裂预警风险评估工具。结果:妊娠期子宫破裂预警风险评估工具包括一般情况、病史情况、症状和体征、相关检查4个维度、27个条目。量表的Cronbach′sα系数为0.760,重测信度为0.879,总量表的评定者间信度为0.940;量表的内容效度为0.920,各维度得分和总分相关系数为0.658~0.808,各条目之间的相关性系数为0.557~0.780;探索性因子分析提取6个公因子,方差累计贡献率为70.17%。结论:构建的妊娠期子宫破裂预警风险评估工具内容可靠、科学,将有助于急诊科护士快速、准确识别子宫破裂的高危病人,对提高临床危重孕产妇救治能力,减少子宫破裂的发生,降低母婴死亡率具有重要的临床指导意义。

妊娠晚期子宫浆膜下血管自发性破裂出血4例报告及文献分析

妊娠期子宫血管自发性破裂导致腹腔内出血是临床罕见的产科严重并发症,误诊率极高,若不及时诊治,围产儿死亡率较高。本文报道北京市海淀区妇幼保健院收治的4例妊娠晚期子宫浆膜下血管自发性破裂病例,分析其发病因素、临床表现、诊治过程及母婴结局,以提高对本病的认识。

瘢痕子宫妊娠无症状型子宫破裂1例报告

子宫破裂是一种严重的产科并发症,指在分娩期或妊娠期间,子宫体部或子宫下段发生破裂,导致母儿灾难性后果。本研究回顾性分析1例瘢痕子宫妊娠无症状型子宫破裂患者的临床资料,探讨瘢痕子宫妊娠的处理策略。

基层医院收治完全性子宫破裂5例的临床分析

完全性子宫破裂是指子宫体部或子宫下段发生破裂,严重威胁母婴生命健康。妊娠期及分娩期早期识别并处理完全性子宫破裂,能够预防分娩不良结局。该文对5例完全性子宫破裂救治过程进行分析,同时结合子宫破裂的原因、临床表现及母婴预后展开讨论。

一例布偶猫分娩期单子宫扭转破裂的病例报告

一只2岁布偶猫,体重4.3 kg,怀孕61 d,精神不好,血常规检查严重贫血,腹部彩超检查死胎、子宫扭转、子宫破裂、血腹,诊断为子宫扭转破裂。母猫交叉配血后输血60 mL,呼吸麻醉,行卵巢子宫切除术,术后消炎止血,1周拆线恢复。

妊娠晚期自发性子宫破裂1例报告

子宫破裂是妊娠期及分娩期严重的并发症之一,是指子宫体部或子宫下段肌层连续性中断,严重威胁母婴健康。本文报道衢州市衢江区妇幼保健院妇产科1例自发性子宫破裂患者的临床诊治过程,患者因“停经38+5周,不规则下腹痛1 d”入院,第二产程因胎心监护频发晚期减速,考虑急性胎儿宫内窘迫,即刻行子宫下段剖宫产术,术中发现子宫破裂,行子宫破裂修补术,术后产妇恢复良好,术后8d母婴出院。现回顾性分析该病例特点,以期为后续自发性子宫破裂的诊治提供参考。

瘢痕子宫中期妊娠引产子宫破裂的抢救与护理分析

目的分析适用于瘢痕子宫中期引产子宫破裂孕妇的抢救及护理措施。方法选取本院妇产科收治的15例瘢痕子宫中期妊娠引产子宫破裂孕妇为观察组,与此同时,查阅本院及其他医院收治的15例瘢痕子宫中期妊娠引产子宫破裂孕妇为对照组。对照期孕妇在引产期间接受常规治疗及护理,梳理相关过程,观察组孕妇在引产期间为其提供针对性抢救及护理措施。比较两组存活率及对治疗及护理工作的满意度。结果观察组孕妇经过急救后全部脱离生命危险,存活率为100%;对照组孕妇有1例因抢救无效而死亡,存活率为93.33%,两组比较差异无统计学意义(P>0.05)。观察组对治疗及护理总满意率为100%,高于对照组的53.33%(P<0.05)。结论针对瘢痕子宫中期妊娠引产孕妇,医护人员应提前了解孕妇所有情况,做好引产过程出现子宫破裂的急救与护理准备,可确保孕妇安全,又可获得其理解和认可。

妊娠晚期子宫下段瘢痕高频超声影像学特征及意义

目的应用高频超声检查妊娠晚期子宫下段瘢痕,为妊娠分娩方式的选择提供参考。方法 118例剖宫产后再次妊娠患者,在妊娠36～40周,经腹超声检查胎儿后,换用频率7.5～12 MHz的高频探头,观察子宫下段瘢痕的高频超声表现特征,并与再次剖宫产时术中子宫下段不全破裂及瘢痕愈合不良等情况进行分析比较。结果妊娠晚期子宫下段瘢痕的高频超声表现特征分为"截断状"(6.8%,8/118)、"鼠尾状"(44.1%,52/118)、"均匀一致"(49.1%,58/118)3种类型。"截断状"型诊断不全破裂、"鼠尾状"型诊断瘢痕愈合不良、"均匀一致"型诊断瘢痕愈合正常的符合率均分别高于其他两型(χ2值分别为20.42、19.03、33.08,P均<0.001)。以"截断状"型诊断不全破裂、"鼠尾状"型诊断瘢痕愈合不良、"均匀一致"型诊断瘢痕愈合正常的敏感性、特异性、阳性预测值、阴性预测值分别为80.0%、96.5%、50%、99.0%,70.0%、73.8%、67.3%、76.2%,72.9%、74.6%、74.1%、73.3%。结论高频超声能显示妊娠晚期子宫下段瘢痕的变化,是判断子宫下段不全破裂、瘢痕愈合不良、瘢痕愈合正常的有效方法。为避免子宫破裂的发生,高频超声显示为"截断状"和"鼠尾状"的患者,应慎重选择阴道试产。

超声检测孕晚期子宫前壁下段厚度在预测瘢痕子宫术中破裂风险中的应用价值

目的探讨经腹超声检测孕晚期子宫前壁下段厚度在预测瘢痕子宫再次分娩时术中发生破裂风险的价值。方法 2015年1月—2016年1月选择于丽水市人民医院分娩的瘢痕子宫孕妇150例,再次剖宫产前3 d内,应用经腹超声检测子宫前壁下段厚度。分析术中所见子宫前壁下段破裂情况(分为破裂组和未破裂组)与子宫前壁下段厚度之间的关系。绘制受试者工作特征(ROC)曲线评价子宫前壁下段厚度预测瘢痕子宫术中破裂风险的价值。结果破裂组53例,未破裂组97例。破裂组与非破裂组子宫前壁下段厚度分别为(1.21±0.34)、(2.17±0.53)mm,差异有统计学意义(t=12.009,P<0.05)。子宫前壁下段厚度预测瘢痕子宫术中破裂风险的截断值为1.55 mm,其灵敏度为0.903,特异度为0.210,ROC曲线下面积为0.913。结论当子宫前壁下段厚度<1.55 mm时提示瘢痕子宫术中发生破裂的风险较高。

妊娠期瘢痕子宫破裂11例病例分析及文献复习

目的分析与探讨妊娠期瘢痕子宫破裂的临床特点、高危因素和预防,改善孕产妇及胎儿的妊娠结局。方法回顾性分析2000年1月至2016年6月我院收治的11例妊娠期完全性子宫破裂病例的临床特征,并复习相关文献。根据患者的既往子宫手术的类型,我们将所有病例分为剖宫产手术组(4例)和妇科手术组(7例)。结果 11例病例中,4例(36.4%)为剖宫产史的瘢痕子宫,既往均为无宫缩的择期剖宫产分娩;7例(63.6%)为子宫肌瘤剔除术后的瘢痕子宫,其中5例为单次子宫肌瘤剔除,1例子宫肌瘤两次手术史,1例为不同部位子宫手术史2次(子宫肌瘤剔除术、宫腔镜子宫内膜多发息肉切除术)。本次妊娠中,剖宫产史组发生子宫破裂的平均孕周(23.8±6.5)周,肌瘤剔除史发生破裂组为(34.6±5.2)周。母胎预后:10例产妇存活,1例因失血性休克继发缺血缺氧脑病死亡。5例新生儿健康存活,5例胎儿就诊时已经胎死宫内,1例新生儿重度窒息并发缺血缺氧性脑病死亡。结论谨慎处理子宫体手术中子宫创面的缝合,避免子宫瘢痕愈合不良。做好瘢痕子宫患者的孕前评估及妊娠时机的选择。加强瘢痕子宫患者的孕期随诊,改善妊娠结局。

妊娠晚期及分娩期子宫破裂17例临床分析

目的:探讨妊娠晚期及分娩期子宫破裂的临床特征、诊治情况及母儿预后。方法:回顾分析2012年1月至2016年6月南方医科大学附属深圳市妇幼保健院收治的17例子宫破裂患者的临床特点、诊断、治疗及预后。结果:妊娠晚期子宫破裂10例,分娩期子宫破裂7例。17例均有子宫手术或异位妊娠手术史,其中子宫下段剖宫产11例,腹腔镜下子宫肌瘤剔除术1例,腹腔镜下异位妊娠手术5例(4例宫角切除术,1例2次输卵管切除术史)。患者合并产后出血5例,其中失血性休克2例,均行子宫破裂修补术,术后恢复良好。胎婴结局中发生死胎1例;新生儿重度窒息1例(新生儿期死亡);新生儿轻度窒息2例,均未发现神经系统后遗症;余13例新生儿预后良好。结论:瘢痕子宫再妊娠者,妊娠晚期出现持续性腹痛症状及分娩期出现胎心异常均应警惕子宫破裂可能。建立紧急剖宫产反应团队能有效改善母儿预后。

超声在诊断妊娠中晚期患者子宫自发破裂中的应用价值

目的探讨子宫破裂的超声声像图特点、发生的危险因素及超声检查的临床价值。方法选择2012年1月至2016年10月经手术证实为妊娠合并子宫自发破裂的孕妇19例,年龄18~45岁,平均年龄31.5岁;孕周11~41周,平均孕周28周。行超声图像检查。对孕妇进行手术治疗。分析超声诊断准确率。结果 19例子宫破裂手术治疗证实,6例为完全子宫破裂,13例为部分子宫破裂。超声诊断6例为完全子宫破裂,12例为部分子宫破裂,1例误诊为妊娠合并子宫肌瘤,准确率94.7%。超声图像特点主要表现为完全子宫破裂时,子宫肌层连续性完全中断,进行性腹腔游离液增多;部分子宫破裂时,子宫肌层连续性中断,而浆膜层连续,羊膜囊可向外膨出。残角子宫破裂发现正常宫颈与残角子宫体相连,在其后方可见一正常子宫体回声。结论子宫破裂声像图虽表现复杂多样,但子宫肌层不连续是子宫破裂诊断的重要依据;超声在诊断子宫破裂、指导临床及时处理中具有重要的价值。

宫颈Bishop评分动态观察在剖宫产术后再次妊娠阴道分娩中预防子宫破裂的价值

目的动态观察宫颈Bishop评分在预测剖宫产术后再次妊娠阴道分娩(VBAC)中子宫破裂的价值。方法对2013年6月至2014年3月禄丰县人民医院70例VBAC(研究组)的分娩结局及母婴并发症进行回顾性分析,并和同期首次阴道分娩70例患者进行对照。结果研究组55例阴道试产成功,成功率78.5%;对照组63例阴道试产成功,成功率90.0%,两组阴道分娩率无统计学差异(x^2=3.45,P=0.06)。研究组因宫颈条件不良行剖宫产率(17.1%)显著高于对照组(0.04%)x^2=11.43,P<0.05。研究组4例新生儿轻度窒息,对照组6例新生儿轻度窒息,两组无显著性差异(x^2=0.43,P=0.05),两组产后出血量比较无显著性差异(t=0.67,P=0.30)。结论剖宫产术后再次妊娠符合阴道分娩条件者在严密监护下阴道分娩是安全的,但阴道试产4小时后宫颈Bishop评分变化≤2分,建议及时终止妊娠,预防子宫破裂。

剖宫产术后再次妊娠经阴道分娩的研究进展

近年来我国随着"全面放开二胎"生育政策的实施,既往高剖宫产率,使得瘢痕子宫再次妊娠问题日益受到重视。剖宫产的死亡率和并发症随着剖宫产次数增加而增加。无论是剖宫产术后再次妊娠阴道试产(TOLAC),还是选择性再次剖宫产(ERCS),都有可能出现严重的临床并发症,这给产科临床实践带来了巨大的挑战。对于这类人群选择何种方式分娩是广大孕妇及产科医师面临的困难选择。近年来,TOLAC已得到国内外的广泛认可,认为是许多有剖宫产史孕妇的合理选择,成功阴道分娩是降低总体剖宫产率的有效途径。该文就TOLAC的研究进展进行综述,以期更好指导临床工作,提高产科服务质量。