Okafor U V, Aniebue U
Department of Anaesthesia, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
Int J Obstet Anesth. 2006 Apr;15(2):124-8. doi: 10.1016/j.ijoa.2005.10.009. Epub 2006 Feb 20.
An observational retrospective study was conducted at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria to determine the outcome for patients with rupture of the gravid uterus who had anaesthesia for laparotomy over a four-year period, July 2000 to June 2004.
The hospital records (case files, labour ward and theatre records) of patients over a four-year period with rupture of the uterus were reviewed.
A total of 2707 deliveries took place at UNTH, Enugu, Nigeria. There were 2556 live births (94.8% of deliveries) and 714 (26.4%) caesarean deliveries. Twenty-three cases of uterine rupture occurred, giving a prevalence of 8.5/1000 deliveries. In nine patents (39.1%) the uterus was already scarred. The patients' mean age was 30.2 years. No nulliparous patients suffered ruptured uterus. General anaesthesia with muscle relaxants was administered to all patients. Twenty-two patients (95.6%) received blood transfusions. All the patients received normal saline and one patient also received Haemacel. Five (21.7%) patients had preoperative hypotension and two (8.6%) had intraoperative hypotension. There was one maternal death which occurred three days after the cesarean section. Twenty-three (96.3%) fetal deaths, including the loss of a set of twins, were recorded. Fetal deaths from ruptured uterus represented 32.4% of all fetal loss following caesarean section during the study period. There were no neonatal deaths.
Rupture of the gravid uterus presents the anaesthetist with the unique challenge of maintaining haemodynamic status before haemostasis is secured, often with the patient in shock. Choice of anaesthetic drugs and availability of blood are important, as well as the skill and experience of the anaesthetist. The maternal mortality rates in other West African studies reviewed were generally higher than those in this series. The maternal outcome re-emphasises the vital role of prompt intervention and availability of blood in reducing maternal mortality following rupture of the uterus.
在尼日利亚埃努古的尼日利亚大学教学医院（UNTH）开展了一项观察性回顾性研究，以确定2000年7月至2004年6月这四年期间接受剖腹探查术麻醉的妊娠子宫破裂患者的治疗结果。
回顾了四年期间子宫破裂患者的医院记录（病例档案、产房和手术室记录）。
在尼日利亚埃努古的UNTH共发生了2707例分娩。有2556例活产（占分娩的94.8%）和714例（26.4%）剖宫产。发生了23例子宫破裂，患病率为8.5/1000次分娩。9例（39.1%）患者子宫已有瘢痕。患者的平均年龄为30.2岁。无未产妇发生子宫破裂。所有患者均给予使用肌肉松弛剂的全身麻醉。22例（95.6%）患者接受了输血。所有患者均接受了生理盐水，1例患者还接受了贺斯。5例（21.7%）患者术前低血压，2例（8.6%）患者术中低血压。有1例产妇死亡，发生在剖宫产术后三天。记录到23例（96.3%）胎儿死亡，包括一对双胞胎的死亡。研究期间，子宫破裂导致的胎儿死亡占剖宫产术后所有胎儿死亡的32.4%。无新生儿死亡。
妊娠子宫破裂给麻醉医生带来了独特的挑战，即在止血前维持血流动力学状态，而患者通常处于休克状态。麻醉药物的选择和血液的可获得性很重要，麻醉医生的技能和经验也很重要。回顾的其他西非研究中的产妇死亡率通常高于本系列研究。产妇结局再次强调了及时干预和血液可获得性在降低子宫破裂后产妇死亡率方面的重要作用。
