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Abstract：
BACKGROUND: There is need to put forward more symptoms and signs that could suggest a diagnosis of uterine rupture so that clinicians\' suspicion is increased; there is also need to put forward uncommon intraoperative findings in patients with uterine rupture to correlate with the signs and symptoms of patients.
METHODS: A 33 year old Gravida 5 Para 4 + 0 with 2 previous caesarean section scars at 28 weeks of amenorrhoea, presented to hospital complaining of lower abdominal pain for 11 h. She had no vaginal bleeding or vaginal discharge or pain on passing urine. On examination she had no pallor, pulse rate was 84 bpm, blood pressure was 110/80 mm of mercury (mmHg), fundal height was 27 cm (cm), fetal heart rate was regular at 150 beats per minute (bpm) and her cervix had a parous os. She was diagnosed with preterm labour and given dexamethasone intramuscularly, then an obstetric ultrasound scan was done and it revealed severe oligohydramnios. Decision do deliver her by emergency caesarean section was made and intraoperative findings were of a uterine rupture along the uterine scar with a fetal arm protruding through and vernix caseosa in the peritoneal cavity, without active uterine bleeding. The patient recovered well postoperatively.
CONCLUSIONS: There is need to suspect uterine rupture in pregnant women with previous caesarean section scars if they present with abdominal pain and are found to have severe oligohydramnios despite having no history of any vaginal discharge, even when the fetal heart rate is normal and they are haemodynamically stable and without vaginal bleeding and remote from term.
METHODS: A 33 year old Gravida 5 Para 4 + 0 with 2 previous caesarean section scars at 28 weeks of amenorrhoea, presented to hospital complaining of lower abdominal pain for 11 h. She had no vaginal bleeding or vaginal discharge or pain on passing urine. On examination she had no pallor, pulse rate was 84 bpm, blood pressure was 110/80 mm of mercury (mmHg), fundal height was 27 cm (cm), fetal heart rate was regular at 150 beats per minute (bpm) and her cervix had a parous os. She was diagnosed with preterm labour and given dexamethasone intramuscularly, then an obstetric ultrasound scan was done and it revealed severe oligohydramnios. Decision do deliver her by emergency caesarean section was made and intraoperative findings were of a uterine rupture along the uterine scar with a fetal arm protruding through and vernix caseosa in the peritoneal cavity, without active uterine bleeding. The patient recovered well postoperatively.
CONCLUSIONS: There is need to suspect uterine rupture in pregnant women with previous caesarean section scars if they present with abdominal pain and are found to have severe oligohydramnios despite having no history of any vaginal discharge, even when the fetal heart rate is normal and they are haemodynamically stable and without vaginal bleeding and remote from term.
摘要：
背景：需要提出更多提示子宫破裂诊断的症状和体征，以便增加临床医生的怀疑；还需要提出子宫破裂患者的罕见术中发现，以与患者的体征和症状相关。
方法：一名33岁的Gravida5Para4+0患者，在闭经28周时有2次剖腹产疤痕，住院，抱怨下腹痛11小时。她没有阴道出血或阴道分泌物或尿液疼痛。经过检查，她没有脸色苍白，脉搏率是84bpm，血压为110/80mmHg，底高27cm(cm),胎儿心率正常，每分钟150次（bpm），她的子宫颈有一个产房。她被诊断为早产，并肌注地塞米松，然后进行了产科超声扫描，发现严重的羊水过少。做出了紧急剖腹产分娩的决定，术中发现子宫沿着子宫疤痕破裂，胎儿手臂伸出，腹膜腔内有胎膜，无活动性子宫出血。患者术后恢复良好。
结论：有剖腹产疤痕的孕妇如果出现腹痛，尽管没有任何阴道分泌物史，但发现有严重羊水过少，则需要怀疑子宫破裂。即使胎儿心率正常，血流动力学稳定，没有阴道出血，远离足月。
方法：一名33岁的Gravida5Para4+0患者，在闭经28周时有2次剖腹产疤痕，住院，抱怨下腹痛11小时。她没有阴道出血或阴道分泌物或尿液疼痛。经过检查，她没有脸色苍白，脉搏率是84bpm，血压为110/80mmHg，底高27cm(cm),胎儿心率正常，每分钟150次（bpm），她的子宫颈有一个产房。她被诊断为早产，并肌注地塞米松，然后进行了产科超声扫描，发现严重的羊水过少。做出了紧急剖腹产分娩的决定，术中发现子宫沿着子宫疤痕破裂，胎儿手臂伸出，腹膜腔内有胎膜，无活动性子宫出血。患者术后恢复良好。
结论：有剖腹产疤痕的孕妇如果出现腹痛，尽管没有任何阴道分泌物史，但发现有严重羊水过少，则需要怀疑子宫破裂。即使胎儿心率正常，血流动力学稳定，没有阴道出血，远离足月。
