Ayres A W, Johnson T R, Hayashi R
Department of Obstetrics & Gynecology, MFM Division, University of Michigan, Ann Arbor, MI, USA.
Int J Gynaecol Obstet. 2001 Sep;74(3):235-40. doi: 10.1016/s0020-7292(01)00445-3.
To identify the fetal heart rate patterns that occurred in a 2-h period of time preceding uterine rupture.
The fetal monitor strips and the medical records of patients with a confirmed diagnosis of uterine rupture were reviewed. These patients delivered at the University of Michigan Hospital from January 1, 1985 to December 31, 1999 and were >or =28 weeks gestational age. Asymptomatic uterine scar dehiscences were excluded. The weeks of gestation, the number of cesarean sections, the surgical findings, and the maternal complications were obtained from the review of the maternal records. The fetal monitor strips for the 2 h preceding the uterine rupture were analyzed, and the fetal heart rate patterns were classified.
During the study period, there were 11 patients identified with uterine rupture. Seven of the 11 (64%) had operative or post-operative complications. There were no maternal deaths. Review of the eight fetal heart rate tracings available revealed 7/8 (87.5%) with recurrent late decelerations and 4/8 (50%) with terminal bradycardia. All four of the patients with fetal bradycardia were preceded by recurrent late decelerations (100%).
The most common fetal heart rate abnormalities that occurred prior to uterine rupture were recurrent late decelerations and bradycardia. The appearance of recurrent late decelerations may be an early sign of impending uterine rupture.
确定子宫破裂前2小时内出现的胎儿心率模式。
回顾确诊为子宫破裂患者的胎儿监护记录带和病历。这些患者于1985年1月1日至1999年12月31日在密歇根大学医院分娩，孕周≥28周。排除无症状子宫瘢痕裂开。通过回顾产妇记录获取孕周、剖宫产次数、手术发现和产妇并发症。分析子宫破裂前2小时的胎儿监护记录带，并对胎儿心率模式进行分类。
在研究期间，确定有11例患者发生子宫破裂。11例中的7例（64%）有手术或术后并发症。无产妇死亡。回顾可得的8份胎儿心率描记图显示，7/8（87.5%）有复发性晚期减速，4/8（50%）有晚期心动过缓。所有4例有胎儿心动过缓的患者之前均有复发性晚期减速（100%）。
子宫破裂前最常见的胎儿心率异常是复发性晚期减速和心动过缓。复发性晚期减速的出现可能是即将发生子宫破裂的早期迹象。
