目的:评估子宫破裂的频率,临床特征,以及三级转诊中心的孕产妇和新生儿结局。
方法:在三级中心对2010年7月至2022年6月间子宫完全性破裂的资料进行了回顾性调查。
结果:在144474例分娩中,子宫完全性破裂42例,发病率为0.029%。27例子宫瘢痕,15例子宫无瘢痕;瘢痕子宫以子宫下段破裂为主,而子宫体破裂在无瘢痕子宫中占主导地位(P≤0.001)。无瘢痕子宫组1min时Apgar评分为7分以下的新生儿多于瘢痕子宫组(P=0.001)。妇科手术史无显著差异,引产,交货方式,临床特征,产妇结局,新生儿体重,早产率,5分钟阿普加得分,两组新生儿死亡率比较(P>0.05)。
结论:子宫破裂的临床表现主要为腹痛,胎儿心跳异常,或者阴道出血.还应注意以前的子宫手术史。严格的产前管理,早期识别,积极的管理可以帮助改善母婴结局。子宫切除术不是必须的。
OBJECTIVE: To assess the frequency of uterine ruptures, clinical characteristics, and maternal and neonatal outcomes in a tertiary referral center.
METHODS: Information on complete uterine rupture between July 2010 and June 2022 was investigated retrospectively at a tertiary center.
RESULTS: There were 42 cases of complete uterine rupture in 144 474 deliveries, with an incidence rate of 0.029%. Twenty-seven cases had a scarred uterus and 15 had an unscarred uterus; Rupture of the lower uterine segment was predominant in the scarred uterus, whereas rupture of the body of the uterus was predominant in the non-scarred uterus (P ≤ 0.001). Newborns with Apgar score of 7 or less at 1 min in the non-scarred uterus group was more than that in the scarred uterus group (P = 0.001). There were no significant differences in the history of gynecologic surgery, induction of labor, mode of delivery, clinical features, maternal outcomes, neonatal weight, preterm birth rate, 5-min Apgar score, or neonatal mortality between the two groups (P > 0.05).
CONCLUSIONS: The clinical manifestations of uterine rupture are mainly abdominal pain, abnormal fetal heartbeat, or vaginal bleeding. Attention should also be paid to the history of previous uterine surgery. Strict prenatal management, early identification, and aggressive management can help improve maternal and child outcomes. Hysterectomy is not imperative.