子宫破裂的高危因素及治疗现状.pdfVIP

中华临床医师杂志( 电子版)2013 年11 月第7 卷第22 期 Chin J Clinicians(Electronic Edition),November 15,2013,Vol.7,No.22 ·10315 · ·综述· 子宫破裂的高危因素及诊疗现状 刘强 刘华倩 孙雪冰 【摘要】 子宫破裂是指在分娩或妊娠期子宫体或下段发生的破裂，是产科严重并发症，母婴围生期死 亡率极高。子宫破裂分为瘢痕与非瘢痕子宫破裂，分娩过程中超过 90%的子宫破裂发生于既往有剖宫产史 的妇女。瘢痕子宫是子宫破裂最常见的高危因素，其中与前次手术瘢痕的位置、形式，缝合方法、术后愈 合情况及术后妊娠间隔时间等因素密切相关。非瘢痕妊娠子宫破裂罕见，可能与梗阻性难产、子宫收缩药 物使用不当、产科手术损伤及胎盘植入等高危因素有关。而妊娠晚期非瘢痕子宫自发性破裂非常罕见，原 因尚不清楚。分娩过程中突然出现的胎心率异常应考虑是子宫破裂一个潜在的危险信号，而超声检查对于 早期诊断至关重要。子宫破裂一经确诊，在10～30 min 内实施手术是降低围生期永久性损伤以及胎儿死亡 的主要治疗手段，但须综合考虑到子宫损伤的程度、患者生命体征是否平稳、将来的生育要求及医师的技 术等因素选择不同术式。本文将子宫破裂的高危因素及诊疗现状进行综述。 【关键词】 子宫破裂； 诊断； 预后； 高危因素； 治疗 * The high risk factors and current situation of diagnosis and treatment of uterine rupture LIU Qiang , LIU * Hua-qian, SUN Xue-bing. Department of Gynaecology and Obstetrics, The Affiliated Xian Liren Hospital of Xian International University School of Medicine, Xian 710065, China Corresponding author: LIU Hua-qian, Email: liuhuaqian@ 【Abstract 】 Uterine rupture refers to the rupture of uterus or lower uterine segment during delivery or trimester of pregnancy, which is a serious complication of obstetrics and it causes a high mortality rate of mothers and children in the perinatal period. Uterine rupture can be classified into scared and non-scared rupture, and 90% of the uterine rupture during delivery occur in women with a history of cesarean section. Scared uterus is the most common risk factor of uterus rupture, which is closely related to the factors such as the previous location and form of the surgical scar, suture method, postoperative healing situation and pregnancy interval. The non-scared pregnancy uterine rupture is rare, which may be related t