Analysis of maternal and infant outcomes and clinical features in 70 cases of uterine rupture
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摘要:
目的：探讨子宫破裂的母儿结局和临床特点。方法：纳入2009—2020年间南京医科大学附属妇产医院分娩的产妇，根据是否瘢痕子宫、发现子宫破裂的时间节点分组，回顾性分析70例子宫破裂患者的母儿结局和临床特点。结果：①子宫破裂的总发生率为0.054%。②临床表现：23例(32.86%)腹痛，13例(18.57%)阴道流血，9例(12.86%)胎心异常，7例(10.00%) 血流动力学不稳定，11 例(15.71%)血性羊水、病理性缩复环等其他表现，29 例(41.43%)无临床表现。③母儿结局：24 例 (34.29%)发生完全性子宫破裂，4例(5.71%)行子宫切除术，30例(42.86%)发生严重产后出血，21例(30%)大量输血，无产妇死亡；62例新生儿中3例(4.84%)胎死宫内，1例(1.61%)家属放弃抢救，5例(8.06%)新生儿重度窒息，7例(11.29%)新生儿轻度窒息。④与瘢痕子宫破裂相比，非瘢痕子宫破裂多于产后才被发现(66.67% vs. 16.36%，P＜0.05)，其产后出血率(80.00% vs. 32.73%)、大量输血率(66.67% vs. 20.00%)以及住院费用(26 348.68元 vs. 13 859.53元)均显著升高(P＜0.05)，两者的新生儿结局差异无统计学意义(P＞0.05)。⑤在瘢痕子宫中，剖宫产后阴道试产(trial of labor after cesarean，TOLAC)组的完全性子宫破裂率(55%)、产后出血率(60%)、大量输血率(45%)均较选择性重复剖宫产(elective repeat cesarean section，ERCS)组显著增加 (20.00%、17.14%、5.71%，P＜0.05)。⑥临产前和产程中发现破裂者的母儿结局差异无统计学意义(P＞0.05)，但其完全性子宫破裂率(26.19%、11.11%)、大量输血率(16.67%、11.11%)、住院费用(11 576.33 元、14 846.30 元)均低于产后发现破裂者 (63.16%、68.42%、25 310.57元，P＜0.05)。结论：子宫破裂的临床表现主要为腹痛、胎心异常或阴道流血，亦有部分患者无特异性临床表现。非瘢痕子宫破裂者，特别是较迟发现的子宫破裂，可能造成更严重的不良预后。
Abstract:
Objective：To investigate the maternal and infant outcomes and clinical characteristics of uterine rupture. Methods：The clinical characteristics and maternal and infant outcomes of 70 patients with uterine rupture who delivered in Nanjing Medical University Obstetrics and Gynecology Hospital from 2009 to 2020 were retrospectively analyzed according to whether there was scar uterus or not and the time point when uterine rupture was found. Results：① The incidence of uterine rupture in this study was 0.054%. ② Clinical manifestations：23 cases(32.86%)had abdominal pain，13 cases(18.57%)had vaginal bleeding，9 cases(12.86%) had fetal heart abnormalities，7 cases(10%)had hemodynamic instability，11 cases(15.71%)had bloody amniotic fluid，pathological contraction of loops and other manifestations，and 29 cases(41.43%)had no clinical manifestations. ③ Maternal and infant outcomes： There were 24 cases(34.29%)with complete uterine rupture，4 cases(5.71%)with hysterectomy，30 cases(42.86%)with serious postpartum hemorrhage，21 cases(30%)with massive blood transfusion，and no maternal death. Among the 62 newborns，3 cases (4.84%)died intrauterine，1 case(1.61%)was given up rescue by family members，5 cases(8.06%)had severe neonatal asphyxia，7 cases(11.29%)had mild neonatal asphyxia. ④ Compared with scar uterine rupture，non ⁃ scar uterine rupture was more thanpostpartum rupture(66.67% vs. 16.36%，P ＜ 0.05). Postpartum bleeding rate(80.00% vs. 32.73%)，massive transfusion rate(66.67% vs. 20.00%)and hospitalization cost(26 348.68 yuan vs. 13 859.53 yuan)were significantly increased(P ＜ 0.05)，but there was no significant difference in neonatal outcomes between the two groups(P ＞ 0.05). ⑤ In scarred uterus，the rate of complete uterine rupture (55%)，postpartum hemorrhage(60%)and massive transfusion(45%)in TOLAC group were significantly higher than those in ERCS group(20.00%，17.14%，5.71%，P ＜ 0.05). ⑥ There was no significant difference in maternal and infant outcomes of patients with rupture before and during labor(P ＞ 0.05). However，the rates of complete uterine rupture(26.19% ，11.11%)，massive blood transfusion(16.67%，11.11%)and hospitalization costs(11 576.33 RMB，14 846.30 RMB)were lower than those of postpartum group (63.16%，68.42%，25 310.57 RMB，P ＜ 0.05). Conclusion：In this study，the clinical manifestations of uterine rupture were mainly characterized as abdominal pain，abnormal fetal heart rate or vaginal bleeding，and some patients had no specific clinical manifestations. Non⁃scar uterine rupture，especially if detected late，may result in a more severe adverse outcome.
