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目的探讨妊娠子宫破裂的原因、临床特点及预防措施。方法对13例妊娠子宫破裂的临床资料进行回顾性分析。结果子宫破裂发生以分娩期为主11例,占84.62%;孕中期、孕晚期自然破裂各1例,占15.38%。次全子宫切除6例,占46.15%;全子宫切除1例,占7.69%;子宫修补术6例,占46.15%。胎儿死亡10例占76.92%(其中包括2例晚孕引产,1例中孕自然破裂),无一例孕产妇死亡。主要原因为疤痕子宫占61.54%(8/13),其次为缩宫素应用不当占23.08%(3/13),另外孕前宫腔操作史及梗阻性难产各1例,分别占7.69%(1/13)。主要临床表现是持续性腹部胀痛不适,占76.92%(10/13),其次为失血性贫血表现,占61.54%(8/13),临产后不明原因的胎儿窘迫或死胎(2例引产病例除外)占53.85%(7/13),不明原因的腹水占23.08%(3/13)。结论妊娠子宫破裂的主要原因为疤痕子宫;主要临床表现是持续性腹部胀痛不适;控制剖宫产率,定期产前检查,严密观察产程,提高识别和诊治高危孕产妇能力,可有效预防子宫破裂的发生。
Objective To investigate the causes, clinical features and preventive measures of uterine rupture in pregnancy. Methods The clinical data of 13 cases of uterine rupture during pregnancy were analyzed retrospectively. Results The uterine rupture occurred mainly in the delivery period in 11 cases, accounting for 84.62%. One case of natural rupture in the second trimester and the third trimester of pregnancy, accounting for 15.38%. Subtotal hysterectomy in 6 cases, accounting for 46.15%; hysterectomy in 1 case, accounting for 7.69%; uterine repair in 6 cases, accounting for 46.15%. 10 cases of fetal death accounted for 76.92% (including 2 cases of late pregnancy induced abortion, 1 case of natural rupture of pregnancy), no case of maternal death. The main reason was that scarring uterus accounted for 61.54% (8/13), followed by oxytocin improper application accounted for 23.08% (3/13), another history of uterine operation before pregnancy and obstructive dystocia in 1 case, accounting for 7.69% (1 / 13). The main clinical manifestations were persistent abdominal pain and discomfort, accounting for 76.92% (10/13), followed by hemorrhagic anemia, accounting for 61.54% (8/13), unexplained fetal distress or stillbirth after labor (2 cases of induced abortion ) Accounted for 53.85% (7/13), unexplained ascites accounted for 23.08% (3/13). Conclusions The main reason of uterine rupture in pregnancy is scarring uterus. The main clinical manifestations are persistent abdominal pain and discomfort. Control of cesarean section rate, regular prenatal examination, strict observation of labor process, improvement of identification and diagnosis and treatment of high-risk pregnant women can effectively prevent uterus Cracked happened.