Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA.
Semin Perinatol. 2010 Aug;34(4):267-71. doi: 10.1053/j.semperi.2010.03.005.
Uterine rupture is the most serious complication for women undergoing trial of labor (TOL) after prior cesarean delivery. While rates of uterine rupture vary significantly according to a variety of clinically associated risk factors, the absolute risk for this complication ranges between 0.5 and 4 percent. Previous vaginal delivery and prior successful vaginal birth after cesarean delivery confer the lowest risk of rupture on women attempting TOL. In contrast, multiple prior cesareans, short interpregnancy interval, single layer uterine closure, prior preterm cesarean, labor induction and augmentation have all been suggested in some studies as factors which may increase the rate of uterine rupture. While considering these risk factors is important in counseling women regarding childbirth following cesarean delivery, the infrequency of uterine rupture coupled with relatively weak associations for most risk factors has prevented the development of an accurate prediction tool for uterine rupture. Preliminary studies suggest that sonographic evaluation of the uterine scar may hold some promise for identifying women at risk.
子宫破裂是既往剖宫产术后试产（TOL）女性最严重的并发症。尽管子宫破裂的发生率因各种临床相关危险因素而有显著差异，但该并发症的绝对风险在 0.5%至 4%之间。既往阴道分娩和既往剖宫产术后阴道分娩成功使尝试 TOL 的女性发生破裂的风险最低。相比之下，多次剖宫产、妊娠间隔短、单层子宫关闭、既往早产剖宫产、引产和催产都在一些研究中被认为是可能增加子宫破裂率的因素。虽然在考虑这些危险因素时，对有剖宫产史的女性进行分娩咨询非常重要，但子宫破裂的发生率较低，而且大多数危险因素的相关性相对较弱，这阻碍了建立一种针对子宫破裂的准确预测工具。初步研究表明，超声评估子宫瘢痕可能具有一定的潜力，可以识别有风险的女性。
