Berhe Yibrah, Wall L Lewis
Director of Residency Training and Assistant Professor.
Fulbright Scholar and Visiting Professor, Department of Obstetrics & Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; and Professor of Obstetrics and Gynecology, Department of Obstetrics & Gynecology, School of Medicine, and Professor of Anthropology, Department of Anthropology, College of Arts and Sciences, Washington University, St Louis, MO.
Obstet Gynecol Surv. 2014 Nov;69(11):695-707. doi: 10.1097/OGX.0000000000000123.
Rupture of the gravid uterus is an obstetric catastrophe associated with high levels of maternal-fetal mortality and morbidity.
The aim of this study was to review the clinical experience with uterine rupture in resource-poor countries.
A MEDLINE search of the clinical literature since 1960 was carried out using the headings "uterine rupture" and "ruptured uterus," including the Medical Subject Heading "developing countries." Further bibliographic compilation was assisted by hand searches of references from retrieved articles. The available articles were then reviewed, synthesized, and summarized.
Uterine rupture remains a major obstetric problem in resource-poor countries. In industrialized, high-resource countries, uterine rupture occurs most often in women who have had a previous cesarean delivery, whereas in resource-poor nations, uterine rupture is more commonly associated with obstructed labor, injudicious obstetric interventions/manipulations (often performed by untrained birth attendants), lack of antenatal care, grand multiparity, and poor access to emergency obstetric care. Uterine rupture after a prior cesarean delivery is becoming more common in these countries as more women gain access to emergency obstetric care.
Uterine rupture afflicts the world's poor women disproportionately. In resource-poor settings, uterine rupture is a reflection of ill-equipped, badly managed, and underresourced health care systems that seem largely indifferent to the reproductive health needs of women. The ultimate success (or failure) of these countries depends in large part upon their commitment to maintaining a healthy and productive female population.
妊娠子宫破裂是一种产科灾难，与母婴高死亡率和发病率相关。
本研究的目的是回顾资源匮乏国家子宫破裂的临床经验。
自1960年以来，使用“子宫破裂”和“破裂子宫”等标题对临床文献进行了MEDLINE检索，包括医学主题词“发展中国家”。通过手工检索检索到的文章的参考文献辅助进行进一步的文献编纂。然后对现有文章进行回顾、综合和总结。
子宫破裂在资源匮乏国家仍然是一个主要的产科问题。在工业化、资源丰富的国家，子宫破裂最常发生在有过剖宫产史的女性中，而在资源匮乏国家，子宫破裂更常见于梗阻性分娩、不当的产科干预/操作（通常由未经培训的助产人员进行）、缺乏产前护理、多产以及难以获得紧急产科护理。随着越来越多的女性能够获得紧急产科护理，这些国家先前剖宫产术后的子宫破裂正变得越来越普遍。
子宫破裂对世界上贫困女性的影响尤为严重。在资源匮乏的环境中，子宫破裂反映了医疗保健系统设备不足、管理不善和资源匮乏，这些系统似乎很大程度上对女性的生殖健康需求漠不关心。这些国家最终的成功（或失败）在很大程度上取决于它们对维持健康和有生产力的女性人口的承诺。
