Plaut M M, Schwartz M L, Lubarsky S L
Department of Obstetrics, Northwest Permanente PC, British Columbia, Canada.
Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1535-42. doi: 10.1016/s0002-9378(99)70049-9.
Our purpose is to report our experience with uterine rupture in patients undergoing a trial of labor after previous cesarean delivery in which labor was induced with misoprostol. The literature on the use of misoprostol in the setting of previous cesarean section is reviewed.
This report was based on case reports, a computerized search of medical records, and literature review.
Uterine rupture occurred in 5 of 89 patients with previous cesarean delivery who had labor induced with misoprostol. The uterine rupture rate for patients attempting vaginal birth after cesarean section was significantly higher in those who received misoprostol, 5.6%, than in those who did not, 0.2% (1/423, P =.0001). Review of the literature reveals insufficient data to support the use of misoprostol in the patient with a previous cesarean delivery.
Misoprostol may increase the risk of uterine rupture in the patient with a scarred uterus. Carefully controlled studies of the risks and benefits of misoprostol are necessary before its widespread use in this setting.
我们旨在报告在既往剖宫产术后经米索前列醇引产进行试产的患者中发生子宫破裂的经验。并对米索前列醇在既往剖宫产情况下使用的相关文献进行综述。
本报告基于病例报告、对病历的计算机检索以及文献综述。
89例既往剖宫产且经米索前列醇引产的患者中有5例发生子宫破裂。剖宫产术后尝试经阴道分娩的患者中，使用米索前列醇者的子宫破裂率显著高于未使用者，分别为5.6%和0.2%（1/423，P = 0.0001）。文献综述显示，支持在既往剖宫产患者中使用米索前列醇的数据不足。
米索前列醇可能会增加瘢痕子宫患者子宫破裂的风险。在其广泛应用于这种情况之前，有必要对米索前列醇的风险和益处进行严格对照研究。
