Page 52 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第44卷第6期
·788 · Journal of Nanjing Medical University（Natural Sciences） 2024年6月

·临床研究·

43例子宫破裂的临床分析

林萍萍，樊佳宁，陆倩倩，芮 璨，栾 婷，王新艳 *
南京医科大学附属妇产医院（南京市妇幼保健院）产科，江苏 南京 210004

［摘 要］ 目的：探讨子宫破裂产妇的临床特点和妊娠结局。方法：回顾性分析2016年12月—2022年12月在南京医科大学
附属妇产医院分娩的43例子宫破裂产妇的临床资料，按照是否有子宫手术史，分为瘢痕子宫组和非瘢痕子宫组，比较其临床
特点和妊娠结局，并对20例经阴道试产发生子宫破裂产妇的产时情况进行分析。结果：43例子宫破裂产妇中瘢痕子宫33例，
非瘢痕子宫 10 例；与瘢痕子宫组相比，非瘢痕子宫组术中出血量≥1 000 mL 的比例（P < 0.001）、累积出血量≥1 000 mL 的比
例（P=0.003）更高，输血率更高（P=0.012）。43 例子宫破裂中预期剖宫产 23 例，余 20 例阴道试产者中产后发现子宫破裂组
（13 例）与产时发现子宫破裂组（7例）相比，产后发现子宫破裂组中完全性子宫破裂占比明显增加（P=0.044），输血率显著增加
（P < 0.001），两组相比差异有统计学意义。此外，与产后发现子宫破裂组相比，产时发现子宫破裂组中羊水异常比例和胎心改
变比例增高，虽差异无统计学意义（P > 0.05），但仍需引起临床高度重视。结论：非瘢痕子宫发生子宫破裂时出血量更多，阴道
试产者于产后发现子宫破裂的并发症更严重，分娩前后应密切注意羊水、胎心、生命体征等情况，及时发现子宫破裂，降低母儿
不良妊娠结局的发生率。
［关键词］ 子宫破裂；瘢痕子宫；非瘢痕子宫；阴道试产；剖宫产
［中图分类号］ R714.4 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）06⁃788⁃09
doi：10.7655/NYDXBNSN240182

Clinical analysis of 43 cases of maternal uterine rupture

LIN Pingping，FAN Jianing，LU Qianqian，RUI Can，LUAN Ting，WANG Xinyan *
Department of Obstetrics，the Affiliated Obstetrics and Gynaecology Hospital of Nanjing Medical University（Nanjing
Women and Children’s Healthcare Hospital），Nanjing 210004，China

［Abstract］ Objective：To investigate the clinical characteristics and pregnancy outcomes of women with uterine rupture. Methods：
This retrospective study analyzed clinical data from 43 women who experienced uterine rupture during delivery at the Affiliated
Obstetrics and Gynaecology Hospital of Nanjing Medical University from December 2016 to December 2022. The participants were
divided into scarred and non⁃scarred uterus groups based on their histories of uterine surgery. Additionally，the delivery outcomes of 20
women who underwent vaginal trial of labor was analyzed. Results：Of the 43 cases，33 women involved a scarred uterus group，and 10
women involved a non⁃scarred uterus group. The non⁃scarred uterus group exhibited significantly higher intraoperative blood loss ≥
1 000 mL（P < 0.001）and cumulative blood loss ≥1 000 mL（P=0.003）compared to the scarred uterus group，along with a higher rate
of blood transfusion（P=0.012）. Among those 43 cases，23 women underwent expected cesarean sections，while 20 opted for vaginal
trial delivery. In the vaginal trial delivery patients，there was a notable increase in complete uterine ruptures（P=0.044）and rate of
blood transfusion（P < 0.001）in the group with uterine rupture detected during delivery（7 cases），compared with the group with
uterine rupture detected after delivery（13 cases）. Furthermore，the group with uterine rupture detected during delivery showed a
higher incidence of abnormal amniotic fluid and fetal heart rate changes. Although these differences did not reach statistical
significance（P > 0.05），they still warrant significant clinical attention. Conclusion：Non⁃scarred uterus exhibit more bleeding when
rupture occurs. Patients undergoing vaginal trial delivery who experience postpartum uterine rupture face more severe complications. It
is essential to closely monitor amniotic fluid，fetal heart rate，and vital signs before and after delivery to promptly detect uterine rupture
and reduce adverse pregnancy outcomes.

［基金项目］ 国家自然科学基金（82204469）
∗
通信作者（Corresponding author），E⁃mail：wxynjfybjy@163.com