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子宫破裂2011八年制ppt课件
Uterine Rupture
Zhu Jieping
Shanghai Jiaotong University Affiliated Sixth Peoples Hospital, Dept of Obs Gyn
Epidemiology and Risk Factors
Incidence: varies from country to country
1: 3000~1:18500
A life-threatening obstetric complication of labor
Underlying factors
delays in seeking appropriate care at the onset of labor
a poor referral system
non-attendance of antenatal care
delayed interventions during delivery
lack of skilled human resources and medical consumables
Etiology
Scarred uterus
Cesarean section 剖宫产
Myomectomy肌瘤切除术
Obstructed labour
Contracted pelvis, CPD (头盆不称)
Abnormal fetal position
Abnormal fetus
Iatrogenic factors (医源性因素)
Uterotonics(宫缩剂): Prostaglandins, Oxytocin
Surgical injury: midforceps delivery, breech extraction, internal version
Clinical Manifestation
Threatened uterine rupture
Pathologic retraction ring 病理性缩复环
Lower abdominal pain
Dysuria排尿困难, hematuria 血尿
Fetal anoxia
Clinical Manifestation
Uterine rupture
Incomplete rupture
Complete rupture
Diagnosis
History
Scarred uterus
Obstructed labour
Uterotonics
…
Signs and symptoms
Abdominal pain
Tenderness
Fetal distress
Defferential Diagnosis
Placental abruption
History
Abdominal sign
Ultrasound
Intrauterine infection
History
Fever
Elevated WBC count
Management (1)
Threatened uterine rupture
To inhibit uterine contraction
Tocolysis
Sedatives: Pethidne, anaesthetic 镇静剂
Cesarean section delivery, immediately
Management (2)
Uterine rupture
Anti-shock treatment
Intravenous infusion
Blood transfusion
Operation
破口修补或子宫切除(次全)
Precautions?
Perinatal health care
High risk population
Labor observation
Uterotonic 宫缩剂
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