妇科手术史患者妊娠期子宫破裂临床研究  

Clinical analysis of 10 cases with a history of gynecological operation of uterine rupture in pregnancy

作　　者：李群颖 郑丽婷 于燕 Li Qunying;Zheng Liting;Yu Yan(Department of Obstetrics and Gynecology,Baoan Women's and Children's Hospital,Jinan University,Shenzhen 518102,China)

机构地区：[1]暨南大学附属深圳宝安区妇幼保健院产科,深圳518102

出　　处：《中华产科急救电子杂志》2023年第2期98-102,共5页Chinese Journal of Obstetric Emergency（Electronic Edition）

摘　　要：目的分析有妇科手术史、但无剖宫产手术史的患者妊娠期子宫破裂的病因及临床特点。方法回顾性分析2012年9月至2021年9月深圳市宝安区妇幼保健院收治的无剖宫产病史、有妇科手术史妊娠期子宫破裂患者的临床资料,对患者孕产次、既往手术情况、病史情况、发生子宫破裂孕周、临床表现、术中所见和母婴结局等临床特点进行分析。结果10例发生子宫破裂患者中经产妇6例,初产妇4例;有人工流产史2例,宫腔镜手术史1例,腹腔镜下子宫肌瘤剔除史2例,腹腔镜下宫颈环扎史2例,异位妊娠经腹腔镜治疗史3例;破裂发生孕周<24周1例,>34周5例;以腹痛为主要表现者9例,其中剧烈腹痛2例,胎动减少1例,孕30周胎心改变3例。7例患者获8例新生儿(1例双胎),其中轻度窒息2例,重度窒息6例;死胎2例,流产无生机儿1例。10例产妇子宫均得到有效缝合,术后平稳出院。结论(1)既往有子宫手术史是子宫破裂的高危因素;(2)对有妊娠需求的育龄期女性,行妇科手术时,应严格掌握手术指征、慎重选择手术方式并且注意手术操作,术后进行妊娠指导;(3)对于有过妇科手术史的孕妇,建议产检携带既往妇科手术记录,详细了解手术经过,警惕多次宫腔操作史的孕妇发生子宫破裂的风险;(4)对于腹腔镜下子宫颈环扎孕妇做好高危妊娠监督。Objective To analyze the etiology and clinical characteristics of uterine rupture in pregnant women without history of cesarean section.Methods Retrospective analysis of the clinical data of cases of uterine rupture in patients without history of cesarean section admitted to Shenzhen Bao′an Maternal and Child Health Hospital for the past 10 years from September 2012 to September 2021,the clinical characteristics of the patient′s birth time,previous surgery,medical history,uterine rupture at the age of gestation,clinical manifestations,intraoperative observations,and maternal and infant outcomes were analyzed.Results In 10 cases of uterine rupture,there were 6 multigravidas and 4 first-born women,2 cases with history of artificial abortion,1 case of hysteroscopic surgery,2 cases of laparoscopic uterine fibroid removal,2 cases of laparoscopic sutural cervical,3 cases from ectopic pregnancy through laparoscopic treatment.uterine rupture happened at different gestational ages.1 case occurred at gestational age of less than 24 weeks,and 5 cases of uterine rupture occurred over 34 weeks.9 cases with abdominal pain was the main manifestation.There were 2 cases of severe abdominal pain,1 case was found by decreased fetal motility,and 3 cases were discovered by fetal heart change at the age of pregnancy after 30 weeks.7 cases of fetal survival were obtained.Among the 8 newborns(including twins),2 were mildly asphyxiated and 6 were severely asphyxiated(including twins).2 cases were stillborn and 1 case was aborted.All 10 cases of maternal uterus were effectively sutured and were discharged from the hospital smoothly after surgery.Conclusions(1)Previous history of uterine surgery is a high-risk factor for uterine rupture,but the initial signs are often not obvious,and abdominal pain is the most common manifestation,which is confused with labour pains and difficult to distinguish.(2)For women of childbearing age who have pregnancy needs,when performing gynecological surgery,they should strictly grasp the indications for

关 键 词：子宫破裂 腹痛 妇科外科手术 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]