妊娠期子宫破裂高危因素的研究进展
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摘要
子宫破裂是一种产科严重并发症,其发生率较低,但对产妇及围生儿结局影响较大。子宫破裂由多种因素共同导致,其中最常见的高危因素是由剖宫产及子宫相关手术导致的瘢痕子宫。随着我国二胎政策的放开,原瘢痕子宫再次妊娠,子宫破裂潜在风险增加。此外,非瘢痕子宫破裂的危险因素包括子宫畸形、难产、孕妇年龄、孕次、产次以及药物等,因其受孕妇个人、家庭支持及社会背景等因素影响,故不容忽视。相比分娩期的子宫破裂,妊娠期子宫破裂并发症更为严重,需医务工作者高度重视。现综述妊娠期子宫破裂的影响因素,并对妊娠期子宫破裂的筛查评估提出建议,旨在预防妊娠期子宫破裂,为早发现、早诊断并及时采取措施,避免对母胎造成更严重的伤害提供依据。
Uterine rupture is a sever complication in obstetrics. Thought its prevalence is low, the influences of maternal and perinatal outcome are greater. Many factors can result in uterine rupture, of which scarred uterus following casarean section and other uterus surgery is the most common risk factor. With the two-child policy, the potential risk of uterine rupture increased after pregnancy in women with scarred uterus. In addition to scarred uterus, the other factors including abnormal structures of uterus, dystocia, age, gravidity, parity,and medicine. It cannot be ignored because it′ s affected by the gravida′ s condition, family support and social context. Uterine rupture during pregnancy should be put more attention than delivery due to the devastating complications. We summarized the risk factors of uterine rupture during the pregnancy and provided the suggestion of screening and assessment of uterine rupture, which aims to prevent the uterine rupture during pregnancy. It also provided the basis for the detection, diagnosis and treatment of uterine rupture in early stage to avoid serious maternal and prenatal complications.
Uterine rupture is a sever complication in obstetrics. Thought its prevalence is low, the influences of maternal and perinatal outcome are greater. Many factors can result in uterine rupture, of which scarred uterus following casarean section and other uterus surgery is the most common risk factor. With the two-child policy, the potential risk of uterine rupture increased after pregnancy in women with scarred uterus. In addition to scarred uterus, the other factors including abnormal structures of uterus, dystocia, age, gravidity, parity,and medicine. It cannot be ignored because it′ s affected by the gravida′ s condition, family support and social context. Uterine rupture during pregnancy should be put more attention than delivery due to the devastating complications. We summarized the risk factors of uterine rupture during the pregnancy and provided the suggestion of screening and assessment of uterine rupture, which aims to prevent the uterine rupture during pregnancy. It also provided the basis for the detection, diagnosis and treatment of uterine rupture in early stage to avoid serious maternal and prenatal complications.
引文
[1]张昕蕾,张军,王虹.妊娠期子宫破裂8例报告及文献复习[J].国际妇产科学杂志,2017,44(3):331-335.
[2]Gibbins KJ,Weber T,Holmgren CM,et al.Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus[J].Am J Obstet Gynecol,2015,213(3):382.e1-e6.
[3]Aziz N,Yousfani S.Analysis of uterine rupture at university teaching hospital Pakistan[J].Pak J Med Sci,2015,31(4):920-924.
[4]Nguefack CT,Ekane GH,Yaya EAN,et al.Rupture utérineàl’H觝pital Général de Douala:prévalence,facteurs associés,prise en charge et pronostic[J].Health Sci Dis,2016,17(1):1-6.
[5]Mukasa PK,Kabakyenga J,Senkungu JK,et al.Uterine rupture in a teaching hospital in Mbarara,western Uganda,unmatched casecontrol study[J].Reprod Health,2013,10:29.
[6]Berhe Y,Gidey H,Wall LL.Uterine rupture in Mekelle,northern Ethiopia,between 2009 and 2013[J].Int J Gynaecol Obstet,2015,130(2):153-156.
[7]Vandenberghe G,De Blaere M,Van Leeuw V,et al.Nationwide population-based cohort study of uterine rupture in Belgium:results from the Belgian Obstetric Surveillance System.[J].BMJ Open,2016,6(5):e010415.
[8]Ye J,Zhang J,Mikolajczyk R,et al.Association between rates of caesarean section and maternal and neonatal mortality in the 21st century:a worldwide population-based ecological study with longitudinal data[J].BJOG,2016,123(5):745-753.
[9]Lumbiganon P,Laopaiboon M,Gülmezoglu AM,et al.Method of delivery and pregnancy outcomes in Asia:the WHO global survey on maternal and perinatal health 2007-08[J].Lancet,2010,375(9713):490-499.
[10]Li HT,Luo S,Trasande L,et al.Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China,2008-2014[J].JAMA,2017,317(1):69-76.
[11]刘强,刘华倩,孙雪冰.子宫破裂的高危因素及诊疗现状[J].中华临床医师杂志(电子版),2013,7(22):10315-10320.
[12]李素玉,陈素清,刘照贞,等.妊娠合并子宫破裂病因分析及诊治体会[J].中国妇幼保健,2013,28(4):609-611.
[13]Hesselman S,Hgberg U,Ekholm-Selling K,et al.The risk of uterine rupture is not increased with single-compared with doublelayer closure:a Swedish cohort study[J].BJOG,2015,122(11):1535-1541.
[14]Gambacorti-Passerini Z,Gimovsky AC,Locatelli A,et al.Trial of labor after myomectomy and uterine rupture:a systematic review[J].Acta Obstet Gynecol Scand,2016,95(7):724-734.
[15]Roberge S,Chaillet N,Boutin A,et al.Single-versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture[J].Int J Gynaecol Obstet,2011,115(1):5-10.
[16]El-Agwany AS,Fawzy A.Silent uterine rupture associated with the use of misoprostol during second trimester pregnancy termination in primigravida[J].Arch Perin Med,2015,21(1):57-59.
[17]Bujold E,Gauthier RJ.Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months[J].Obstet Gynecol,2010,115(5):1003-1006.
[18]Kok N,Wiersma IC,Opmeer BC,et al.Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section:a metaanalysis[J].Ultrasound Obstet Gynecol,2013,42(2):132-139.
[19]Sturzenegger K,Schffer L,Zimmermann R,et al.Risk factors of uterine rupture with a special interest to uterine fundal pressure[J].JPerinat Med,2017,45(3):309-313.
[20]林鑫子,黄晨玲子,罗新.剖宫产再次分娩子宫破裂相关危险因素的临床分析[J].中国计划生育和妇产科,2016,8(7):3-5.
[21]Damiani GR,Gaetani M,Landi S,et al.Uterine rupture in a nulliparous woman with septate uterus of the second trimester pregnancy and review in literature[J].Int J Surg Case Rep,2013,4(3):259-261.
[22]朴恩谊.中晚孕期子宫破裂的危险因素及不同处理方案的预后研究[D].杭州:浙江大学,2015.
[23]Marie Bereka T,Mulat Aweke A,Eshetie Wondie T.Associated Factors and Outcome of Uterine Rupture at Suhul General Hospital,Shire Town,North West Tigray,Ethiopia 2016:A Case-Control Study[J].Obstet Gynecol Int,2017,2017:8272786.
[24]Al-Zirqi I,Daltveit AK,Forsén L,et al.Risk factors for complete uterine rupture[J].Am J Obstet Gynecol,2017,216(2):165.e1-e8.
[25]Al-Zirqi I,Stray-Pedersen B,Forsén L,et al.Uterine rupture:trends over 40 years[J].BJOG,2016,123(5):780-787.
[26]Kaczmarczyk M,Sparén P,Terry P,et al.Risk factors for uterine rupture and neonatal consequences of uterine rupture:a populationbased study of successive pregnancies in Sweden[J].BJOG,2007,114(10):1208-1214.
[27]Markou GA,Muray JM,Poncelet C.Risk factors and symptoms associated with maternal and neonatal complications in women with uterine rupture.A 16 years multicentric experience[J].Eur J Obstet Gynecol Reprod Biol,2017,217:126-130.
[28]李航,马润玫,屈在卿.剖宫产后阴道试产子宫破裂的危险因素及其早期识别[J].中华围产医学杂志,2015,18(9):705-708.
[29]Eguzo KN,Lawal AK,Ali F,et al.Patterns of uterine rupture in Nigeria:a comparative study of scarred and unscarred uterus[J].Int JReprod Contracept Obstet Gynecol,2015,4(4):1094-1099.
[2]Gibbins KJ,Weber T,Holmgren CM,et al.Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus[J].Am J Obstet Gynecol,2015,213(3):382.e1-e6.
[3]Aziz N,Yousfani S.Analysis of uterine rupture at university teaching hospital Pakistan[J].Pak J Med Sci,2015,31(4):920-924.
[4]Nguefack CT,Ekane GH,Yaya EAN,et al.Rupture utérineàl’H觝pital Général de Douala:prévalence,facteurs associés,prise en charge et pronostic[J].Health Sci Dis,2016,17(1):1-6.
[5]Mukasa PK,Kabakyenga J,Senkungu JK,et al.Uterine rupture in a teaching hospital in Mbarara,western Uganda,unmatched casecontrol study[J].Reprod Health,2013,10:29.
[6]Berhe Y,Gidey H,Wall LL.Uterine rupture in Mekelle,northern Ethiopia,between 2009 and 2013[J].Int J Gynaecol Obstet,2015,130(2):153-156.
[7]Vandenberghe G,De Blaere M,Van Leeuw V,et al.Nationwide population-based cohort study of uterine rupture in Belgium:results from the Belgian Obstetric Surveillance System.[J].BMJ Open,2016,6(5):e010415.
[8]Ye J,Zhang J,Mikolajczyk R,et al.Association between rates of caesarean section and maternal and neonatal mortality in the 21st century:a worldwide population-based ecological study with longitudinal data[J].BJOG,2016,123(5):745-753.
[9]Lumbiganon P,Laopaiboon M,Gülmezoglu AM,et al.Method of delivery and pregnancy outcomes in Asia:the WHO global survey on maternal and perinatal health 2007-08[J].Lancet,2010,375(9713):490-499.
[10]Li HT,Luo S,Trasande L,et al.Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China,2008-2014[J].JAMA,2017,317(1):69-76.
[11]刘强,刘华倩,孙雪冰.子宫破裂的高危因素及诊疗现状[J].中华临床医师杂志(电子版),2013,7(22):10315-10320.
[12]李素玉,陈素清,刘照贞,等.妊娠合并子宫破裂病因分析及诊治体会[J].中国妇幼保健,2013,28(4):609-611.
[13]Hesselman S,Hgberg U,Ekholm-Selling K,et al.The risk of uterine rupture is not increased with single-compared with doublelayer closure:a Swedish cohort study[J].BJOG,2015,122(11):1535-1541.
[14]Gambacorti-Passerini Z,Gimovsky AC,Locatelli A,et al.Trial of labor after myomectomy and uterine rupture:a systematic review[J].Acta Obstet Gynecol Scand,2016,95(7):724-734.
[15]Roberge S,Chaillet N,Boutin A,et al.Single-versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture[J].Int J Gynaecol Obstet,2011,115(1):5-10.
[16]El-Agwany AS,Fawzy A.Silent uterine rupture associated with the use of misoprostol during second trimester pregnancy termination in primigravida[J].Arch Perin Med,2015,21(1):57-59.
[17]Bujold E,Gauthier RJ.Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months[J].Obstet Gynecol,2010,115(5):1003-1006.
[18]Kok N,Wiersma IC,Opmeer BC,et al.Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section:a metaanalysis[J].Ultrasound Obstet Gynecol,2013,42(2):132-139.
[19]Sturzenegger K,Schffer L,Zimmermann R,et al.Risk factors of uterine rupture with a special interest to uterine fundal pressure[J].JPerinat Med,2017,45(3):309-313.
[20]林鑫子,黄晨玲子,罗新.剖宫产再次分娩子宫破裂相关危险因素的临床分析[J].中国计划生育和妇产科,2016,8(7):3-5.
[21]Damiani GR,Gaetani M,Landi S,et al.Uterine rupture in a nulliparous woman with septate uterus of the second trimester pregnancy and review in literature[J].Int J Surg Case Rep,2013,4(3):259-261.
[22]朴恩谊.中晚孕期子宫破裂的危险因素及不同处理方案的预后研究[D].杭州:浙江大学,2015.
[23]Marie Bereka T,Mulat Aweke A,Eshetie Wondie T.Associated Factors and Outcome of Uterine Rupture at Suhul General Hospital,Shire Town,North West Tigray,Ethiopia 2016:A Case-Control Study[J].Obstet Gynecol Int,2017,2017:8272786.
[24]Al-Zirqi I,Daltveit AK,Forsén L,et al.Risk factors for complete uterine rupture[J].Am J Obstet Gynecol,2017,216(2):165.e1-e8.
[25]Al-Zirqi I,Stray-Pedersen B,Forsén L,et al.Uterine rupture:trends over 40 years[J].BJOG,2016,123(5):780-787.
[26]Kaczmarczyk M,Sparén P,Terry P,et al.Risk factors for uterine rupture and neonatal consequences of uterine rupture:a populationbased study of successive pregnancies in Sweden[J].BJOG,2007,114(10):1208-1214.
[27]Markou GA,Muray JM,Poncelet C.Risk factors and symptoms associated with maternal and neonatal complications in women with uterine rupture.A 16 years multicentric experience[J].Eur J Obstet Gynecol Reprod Biol,2017,217:126-130.
[28]李航,马润玫,屈在卿.剖宫产后阴道试产子宫破裂的危险因素及其早期识别[J].中华围产医学杂志,2015,18(9):705-708.
[29]Eguzo KN,Lawal AK,Ali F,et al.Patterns of uterine rupture in Nigeria:a comparative study of scarred and unscarred uterus[J].Int JReprod Contracept Obstet Gynecol,2015,4(4):1094-1099.