Daniel Seow Choon Koh, Eek Chaw Tan, Hester Chang Qi Qi Lau, Mor Jack N G, Wan Shi Tay, Kok Hian Tan
Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Republic of Singapore.
Division of Obstetrics & Gynecology, KK Women's and Children's Hospital, Republic of Singapore.
Eur J Obstet Gynecol Reprod Biol. 2018 Aug;227:8-12. doi: 10.1016/j.ejogrb.2018.05.016. Epub 2018 May 22.
Uterine rupture is a rare complication in second trimester termination of pregnancy (TOP) with an overall incidence of up to 1.1%. There are concerns that patients with previous caesarean section(s) were at an increased risk of uterine rupture. However, there is no published data in our local population to date. This study aims to identify the incidence and contributing factors for uterine rupture in women undergoing TOP in Singapore.
This is a retrospective review of all women who had TOP between 14 weeks to 23 weeks gestation from January 2005 to December 2014 in a large tertiary hospital. Patients' characteristics and details of TOP were retrieved from pre-existing hospital databases. The gestation age and dose of gemeprost used were retrieved from an internal hospital audit conducted from December 2012 to July 2016.
A total of 3385 patients underwent TOP from 2005 to 2014. An estimated 339 patients had a scarred uterus. Seven cases of uterine rupture were identified, with an overall incidence of 0.21% (7/3385). The incidence of uterine rupture in patients with scarred uterus was 2.1% (7/339). Contributing factors identified included higher mean dose of abortifacient, usage of multiple abortifacients and methods, advanced gestation age and short interval between last caesarean section and current TOP.
Second trimester TOP on scarred uterus warrants careful usage of abortifacient with minimal cumulative dosage and should be carried out in early second trimester gestation whenever feasible. Prostaglandin analogues appeared to be safe for TOP in unscarred uteruses.
子宫破裂是妊娠中期终止妊娠（TOP）的一种罕见并发症，总体发生率高达1.1%。有人担心既往有剖宫产史的患者子宫破裂风险增加。然而，迄今为止，我们当地人群中尚无已发表的数据。本研究旨在确定新加坡接受TOP的女性子宫破裂的发生率及相关因素。
这是一项对2005年1月至2014年12月在一家大型三级医院接受妊娠14周至23周TOP的所有女性进行的回顾性研究。患者特征和TOP细节从现有的医院数据库中检索。使用的孕龄和米索前列醇剂量从2012年12月至2016年7月进行的医院内部审计中检索。
2005年至2014年共有3385例患者接受TOP。估计有339例患者子宫有瘢痕。确定了7例子宫破裂病例，总体发生率为0.21%（7/3385）。子宫有瘢痕的患者子宫破裂发生率为2.1%（7/339）。确定的相关因素包括流产药平均剂量较高、使用多种流产药和方法、孕龄较大以及上次剖宫产与本次TOP间隔时间短。
瘢痕子宫妊娠中期TOP应谨慎使用流产药，累积剂量应最小，并且只要可行应在妊娠中期早期进行。前列腺素类似物似乎对未瘢痕化子宫的TOP是安全的。
