瘢痕子宫阴道试产子宫不全破裂6例临床分析
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摘要
目的:探讨剖宫产后阴道试产(TOLAC)过程中子宫破裂的临床特点、诊治情况及妊娠结局。方法:回顾分析2016年1月至2018年10月浙江大学医学院附属妇产科医院收治的TOLAC过程中发生子宫不全破裂的6例孕产妇的临床病例资料。结果:6例子宫不全破裂产妇中,4例为第一产程中子宫不全破裂中转剖宫产,1例为第二产程中出现胎心频繁晚期减速产钳助产,产后出血行剖腹探查发现子宫不全破裂,1例为平产后发现的子宫不全破裂。4例产程中出现胎心减速(2例频发变异减速,1例延长减速并发血性羊水,1例重复晚期减速);1例表现为产程中持续性下腹疼痛,胎心偏快;1例表现为平产后2h内的产后难治性出血。6例均行剖腹探查术,术中均见瘢痕处肌层缺失,仅剩浆膜层;其中3例出现子宫瘢痕的延裂。6例均行子宫瘢痕裂开的修补缝合,无一切除子宫,母儿预后良好。结论:子宫破裂是TOLAC过程中的危急重症,子宫不全破裂的临床症状不典型,应加强有TOLAC意愿妇女的孕前孕期宣教、注重产前评估,结合母儿情况及前次剖宫产史严密管理产程,关注胎心监护变化及不适主诉,提高子宫破裂早期识别能力,能大大减少子宫破裂引起的相关并发症,保障母儿安全。
引文
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[2] Sturzenegger K,Schaffer L,Zimmermann R,et al.Risk factors of uterine rupture with a special interest to uterine fundal pressure[J].J Perinat Med,2017,45(3):309-313
[3] 李航,马润玫.剖宫产后阴道分娩子宫破裂早期识别与管理[J].中华产科急救电子杂志,2017,6(1):9-13
[4] 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
[5] Practice Bulletin No.184 Summary:vaginal birth after cesarean delivery[J].Obstet Gynecol,2017,130(5):1167-1169
[6] 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
[7] Sahin HG,Kolusari A,Yildizhan R,et al.Uterine rupture:a twelve-year clinical analysis[J].J Matern Fetal Neonatal Med,2008,21(7):503-506
[8] 中华医学会妇产科学分会产科学组.剖宫产术后再次妊娠阴道分娩管理的专家共识(2016)[J].中华妇产科杂志,2016,51(8):561-564
[9] McPherson JA,Strauss RA,Stamilio DM.Nonreassuring fetal status during trial of labor after cesarean[J].Am J Obstet Gynecol,2014,211(4):408 e401-408
[10] 郑媛媛,丁新.剖宫产后阴道试产中子宫破裂的早期识别[J].中华围产医学杂志,2016,19(9):677-680