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发育医学电子杂志  2017, Vol. 5 Issue (4): 248-252    
  围产医学   论著 |产科 |
妊娠晚期子宫破裂14例分析
孙燕 付玉静 翟建军
首都医科大学附属北京同仁医院 妇产科,北京 100176
Analysis of 14 cases of uterine rupture during late pregnancy
SUN Yan, FU Yu-jing, ZHAI Jian-jun
Department of Gynaecology & Obstetrics, Beijing Tongren Hospital, Beijing 100176, China
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摘要 目的  探讨子宫破裂的高危因素、诊治方法及预防措施。方法 2009年1月至2016年9月,在北京同仁医院产科收治的孕妇中,子宫破裂患者14例。均经手术明确诊断。采用回顾性分析的方法,记录每例患者的基本情况,包括年龄、发生子宫破裂的孕周、孕次、产次、既往手术史、发生子宫破裂时的症状和体征,记录子宫破裂及处理情况,以及围产结局。结果  研究期间本院子宫破裂发生率为0.11%(14/13 164)。11例为瘢痕子宫(78.6%,11/14),其中3例为子宫肌瘤剔除术后,8例为剖宫产术后。临床表现包括:1例撕裂样痛,8例腹痛,1例腹胀,4例无明显症状。胎心监测显示:3例胎心消失,6例减速,5例胎心正常。子宫破裂位置为:子宫下段破裂11例,子宫体部破裂2例,子宫底部破裂1例。3例为不全子宫破裂,11例为完全子宫破裂,均给予剖宫产加修补术。1例为双胎,15例围产儿中,3例死胎,3例新生儿重度窒息,3例轻度窒息,其余6例新生儿1分钟Apgar评分均为9分。14例孕妇术后均无感染,恢复良好出院。结论 瘢痕子宫是子宫破裂最常见的原因,应提高子宫肌瘤剔除术的缝合技巧,严格掌握初产妇的剖宫产指征,引产过程中严密监测,提高子宫破裂的诊治能力。
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关键词:  子宫破裂  瘢痕子宫  剖宫产  预防诊治    
Abstract: Objective To explore the risk factors, diagnosis and treatment methods and preventive measures of uterine rupture. Methods From January 2009 to September 2016, 14 cases of pregnant women with uterine rupture in Obstetrics of Beijing Tongren Hospital were included. All the 14 cases were exactly diagnosed by surgery. Retrospective analysis was adopted and the basic situations of each patient were recorded, including age, gestational age of uterine rupture occurrence, gravidity, parity, history of surgery, signs and symptoms of uterine rupture occurrence. And uterine rupture, handling practices and perinatal outcomes were also recorded. Results The incidence of uterine rupture of our hospital was 0.11% (14/13 164) during the study period. 11 cases were scar uterine (78.6%, 11/14), of which 3 cases were after myomectomy, and 8 cases were after cesarean section. Clinical manifestations included: 1 case of lacerating pain, 8 cases of abdominal pain, 1 case of abdominal distention, 4 cases of no obvious symptoms. Fetal heart monitoring revealed: 3 cases of fetal heart stop, 6 cases of deceleration, 5 cases of normal fetal heart. The position of uterus rupture was 11 cases of lower uterus, 2 cases of uterine body and 1 case of bottom uterus. Three cases were incomplete uterus rupture and 11 cases were complete uterus rupture. One case was twin. Among 15 cases of perinatal infants, 3 cases were stillborn, 3 cases were severely asphyxia, 3 cases were mild asphyxia, and the other 6 cases of infants showed 9 points of 1 minute Apgar score. All the 14 cases of pregnant women were not infected and recovered well after operation. Conclusions Scarred uterus is the most common cause of uterine rupture. Suture technique of myomectomy should be improved. Indications of cesarean section should be controlled strictly. During induction, closely monitoring should be given. And the ability of diagnosis and treatment of uterine rupture should be enhanced.
Key words:  Uterine rupture    Scarred uterus    Cesarean section    Preventive treatment
收稿日期:  2016-11-20                出版日期:  2017-10-30      发布日期:  2018-01-24      期的出版日期:  2017-10-30
基金资助: 吴阶平医学基金(320.6750.17095)
通讯作者:  翟建军:https://baike.baidu.com/item/%E7%BF%9F%E5%BB%BA%E5%86%9B/2852307?fr=aladdin    E-mail:  zjjzjj20022002@163.com
引用本文:    
孙燕 付玉静 翟建军. 妊娠晚期子宫破裂14例分析[J]. 发育医学电子杂志, 2017, 5(4): 248-252.
SUN Yan, FU Yu-jing, ZHAI Jian-jun. Analysis of 14 cases of uterine rupture during late pregnancy. Journal of Developmental Medicine(Electronic Version), 2017, 5(4): 248-252.
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