中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
33期
2674-2676
,共3页
贾利英%孟文颖%马海会%田杰
賈利英%孟文穎%馬海會%田傑
가리영%맹문영%마해회%전걸
剖宫产再孕%腔镜剔肌瘤%子宫破裂
剖宮產再孕%腔鏡剔肌瘤%子宮破裂
부궁산재잉%강경척기류%자궁파렬
Cesarean pregnancy again%Laparoscopic myomectomy%Uterine rupture
目的 探讨妊娠子宫破裂的临床特点,提高早期诊断率,降低不良预后.方法 对2003年1月1日至2012年5月31日在北京市通州区妇幼保健院院分娩55 143例产妇进行了分析,其中瘢痕子宫2490例,妊娠子宫破裂68例(瘢痕子宫破裂62例,非瘢痕子宫破裂6例),非瘢痕子宫分娩52 653例.结果 瘢痕子宫破裂与非瘢痕子宫破裂发生率差异有统计学意义(X2=345.549,P＜0.01).经产妇与初产妇比较子宫破裂的发生率差异有统计学意义.剖宫产再次妊娠子宫破裂多发生在子宫下段原手术瘢痕处的不全破裂,破裂多发生在孕39周及以上,超声检测子宫下段瘢痕厚度≤3 mm.腹腔镜剔肌瘤不足1年妊娠3例在孕36 ～ 38周均发生在瘢痕部位的子宫完全破裂.产后出血发生率42.65％(29/62),子宫切除2例.新生儿窒息11例.结论 剖宫产再次妊娠,孕晚期超声监测子宫下段瘢痕厚度≤3 mm,应在39周前终止妊娠；警惕腹腔镜剔肌瘤不足1年妊娠孕晚期子宫破裂；同时加强外来人口和无业孕产妇的管理.
目的 探討妊娠子宮破裂的臨床特點,提高早期診斷率,降低不良預後.方法 對2003年1月1日至2012年5月31日在北京市通州區婦幼保健院院分娩55 143例產婦進行瞭分析,其中瘢痕子宮2490例,妊娠子宮破裂68例(瘢痕子宮破裂62例,非瘢痕子宮破裂6例),非瘢痕子宮分娩52 653例.結果 瘢痕子宮破裂與非瘢痕子宮破裂髮生率差異有統計學意義(X2=345.549,P＜0.01).經產婦與初產婦比較子宮破裂的髮生率差異有統計學意義.剖宮產再次妊娠子宮破裂多髮生在子宮下段原手術瘢痕處的不全破裂,破裂多髮生在孕39週及以上,超聲檢測子宮下段瘢痕厚度≤3 mm.腹腔鏡剔肌瘤不足1年妊娠3例在孕36 ～ 38週均髮生在瘢痕部位的子宮完全破裂.產後齣血髮生率42.65％(29/62),子宮切除2例.新生兒窒息11例.結論 剖宮產再次妊娠,孕晚期超聲鑑測子宮下段瘢痕厚度≤3 mm,應在39週前終止妊娠；警惕腹腔鏡剔肌瘤不足1年妊娠孕晚期子宮破裂；同時加彊外來人口和無業孕產婦的管理.
목적 탐토임신자궁파렬적림상특점,제고조기진단솔,강저불량예후.방법 대2003년1월1일지2012년5월31일재북경시통주구부유보건원원분면55 143례산부진행료분석,기중반흔자궁2490례,임신자궁파렬68례(반흔자궁파렬62례,비반흔자궁파렬6례),비반흔자궁분면52 653례.결과 반흔자궁파렬여비반흔자궁파렬발생솔차이유통계학의의(X2=345.549,P＜0.01).경산부여초산부비교자궁파렬적발생솔차이유통계학의의.부궁산재차임신자궁파렬다발생재자궁하단원수술반흔처적불전파렬,파렬다발생재잉39주급이상,초성검측자궁하단반흔후도≤3 mm.복강경척기류불족1년임신3례재잉36 ～ 38주균발생재반흔부위적자궁완전파렬.산후출혈발생솔42.65％(29/62),자궁절제2례.신생인질식11례.결론 부궁산재차임신,잉만기초성감측자궁하단반흔후도≤3 mm,응재39주전종지임신；경척복강경척기류불족1년임신잉만기자궁파렬；동시가강외래인구화무업잉산부적관리.
ObjectiveTo explore the clinical characteristics of pregnant uterine rupture,enhance its early diagnosis rate and improve its prognosis.Methods For this retrospective study,a total of 55 143 delivery cases at Tongzhou District Maternal & Child Health Hospital from January 1,2003 to May 31,2012 was analyzed.There were 2490 cases of scarred uterus and 68 cases had uterine rupture.And 62 of them belonged to scarred uterus rupture.And there were 52 653 cases of non-scarred uterus childbirth and 6 of them had rupture.Results Significant differences existed in the rupture of scarred versus non-scarred uterus and maternal versus primipara women.Uterus rupture usually occurred at the incomplete rupture position of original surgical scar at 39 weeks or more.The scar thickness of lower uterine segment was ≤ 3 mm on ultrasound.Three cases with laparoscopic myoma removal within 1 year had complete rupture at 36-38 weeks.Postpartum hemorrhage incidence was 42.65％.There were two cases of hysterectomy and 11 cases of neonatal asphyxia.Conclusion For second pregnancy of cesarean section,pregnancy should be terminated before 39 weeks if scar thickness of lower uterine segment is ≤ 3 nun.Late rupture is to be monitored closely for those with laparoscopic myoma removal within 1 year.Meanwhile,we should strengthen the management of migrant and unemployed women.
