Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.
Department of Obstetrics and Gynecology, St Marianna University School of Medicine, Kanagawa, Japan.
J Matern Fetal Neonatal Med. 2021 Mar;34(5):663-669. doi: 10.1080/14767058.2019.1611775. Epub 2019 May 23.
The aim of the present study was to clarify the obstetric factors associated with uterine rupture in mothers who deliver infants with cerebral palsy (CP) in Japan. This retrospective case-cohort study reviewed the obstetric characteristics and clinical courses of mothers who experienced uterine rupture and compared those who delivered an infant with CP (cases) with those who delivered an infant without CP (cohort). Data were obtained from the Japan Obstetric Compensation System for CP database (27 cases) and the perinatal database of the Japan Society of Obstetrics and Gynecology (312 cohorts). The subjects included live singleton infants delivered between 2009 and 2014 with a birth weight ≥2000 g and gestation ≥33 weeks. Augmentation was performed 33% in cases and 8% in cohorts ( < .001). The amount of bleeding during surgery was 1819 g in cases and 1096 g in cohorts ( < .001). Length of gestational weeks and neonatal birth weight were significantly higher and Apgar scores and umbilical arterial pH were lower in cases compared to cohorts ( < .001). In cases with CP, 11 cases of uterine rupture involved scarred uteruses. Seven were trial of labor after a previous cesarean. On one hand, 16 cases occurred in unscarred uteruses. Five of the uterine fundal pressure maneuvers and four of tachysystole due to excessive augmentation were reported in association with uterine rupture. Two-third of the relevant obstetric factors for CP associated with uterine rupture were iatrogenic. At least, to reduce CP resulting from delivery-related uterine rupture, reckless delivery management should be avoided.
本研究旨在阐明日本脑瘫（CP）患儿母亲发生子宫破裂的产科相关因素。这项回顾性病例队列研究回顾了发生子宫破裂的母亲的产科特征和临床过程，并将这些母亲与分娩 CP 婴儿（病例）和未分娩 CP 婴儿（队列）的母亲进行了比较。数据来自日本 CP 产科补偿系统数据库（27 例）和日本妇产科协会围产期数据库（312 个队列）。研究对象包括 2009 年至 2014 年间分娩的活单胎婴儿，出生体重≥2000g，胎龄≥33 周。病例组中有 33%的产妇行催产，而队列组中有 8%（ < .001）。病例组术中出血量为 1819g，队列组为 1096g（ < .001）。与队列组相比，病例组的孕周和新生儿出生体重显著更高，而 Apgar 评分和脐动脉 pH 值更低（ < .001）。在 CP 病例中，11 例子宫破裂涉及瘢痕子宫。其中 7 例为前次剖宫产试产。另一方面，16 例发生在非瘢痕子宫中。与子宫破裂相关的相关产科因素中，有 5 例与子宫底部压力操作有关，有 4 例与过度催产导致的心动过速有关。与 CP 相关的导致子宫破裂的产科因素中有三分之二是医源性的。至少，为了减少因分娩相关子宫破裂导致的 CP，应避免草率的分娩管理。
