妊娠期非剖宫产切口子宫破裂的原因分析  

Analysis of the Causes of Uterus Rupture without Previous Cesarean Section

作　　者：郝丽英[1] HAO Liying(Department of Perinatology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院围产医学部,北京100026

出　　处：《医学综述》2018年第16期3307-3311,共5页Medical Recapitulate

摘　　要：目的探讨妊娠期非剖宫产切口子宫破裂的原因。方法对2011年1月至2017年12月首都医科大学附属北京妇产医院收治的13例妊娠期非剖宫产切口子宫破裂的临床资料进行回顾性分析。结果本研究统计的妊娠期非剖宫产切口子宫破裂发生率约为0.01%(13/128 242),发病原因依次为腹腔镜或经腹子宫肌瘤或子宫腺肌瘤剔除术史(8/13)、人工流产或药物流产史(7/13)、宫腔镜手术史(3/13)、胎盘植入(2/13)、子宫部分切除术史(1/13)、输卵管切除术史(1/13)及巨大胎儿(1/13),术前估计出血量600~4 500 m L、孕产妇结局良好,均存活并保留子宫,胎儿或新生儿不良结局严重,胎死宫内和新生儿重度窒息共7例。结论各种形式的子宫瘢痕是妊娠期非剖宫产切口子宫破裂的主要原因,临床医师应对此提高警惕,正确诊断处理,以最大程度地减少不良结局。Objective To investigate the causes of uterine rupture without previous cesarean section. Methods Clinical data of 13 cases with uterine rupture without previous cesarean section in Beijing Obstetrics and Gynecology Hospital,Capital Medical University,from Jan. 2011 to Dec. 2017,were studied retrospectively. Results The incidence of uterine rupture without previous cesarean section was 0. 01%（ 13/128 242）,the causes included previous laparoscopic/transabdominal myomectomy or adenomyomectomy（ 8/13）,previous surgical and medical abortion（ 7/13）,previous hysteroscopic surgery（ 3/13）,placenta implantation（ 2/13）,previous partial hysterectomy（ 1/13）,previous salpingectomy（ 1/13） and macrosomia（ 1/13）,estimated blood loss before laparotomy was 600-4 500 m L,all 13 cases survived and their uteruses were repaired without hysterectomy,while the outcomes of the fetuses and newborns were worse,7/13 cases ended up with intrauterine fetal death and severe asphyxia of newborn. Conclusion Uterine scar caused by all kinds of reasons is the leading cause of uterine rupture without previous cesarean section. Obstetricians should be alert to those causes to make correct diagnosis and accurate management to minimize the adverse perinatal outcome.

关 键 词：妊娠期 子宫破裂 发病原因 

分 类 号：R714.7[医药卫生—妇产科学]