Department of Obstetrics and Gynecology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey.
Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey.
Ginekol Pol. 2020;91(2):95-90. doi: 10.5603/GP.a2020.0012. Epub 2020 Feb 21.
The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred uterine rupture and in those with a history of uterine rupture MATERIAL AND METHODS: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone fertility-preserving surgery were evaluated.
During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in 67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in 60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these, eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36-37 wk. of gestation, and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively.
The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be validated in another studies.
本研究旨在探讨未瘢痕子宫破裂和有子宫破裂史的患者的发生率、病因和产科结局。
回顾性分析 2005 年 5 月至 2017 年 5 月在一家三级中心分娩的妇女的医院记录。评估了在妊娠期间行保留生育功能手术的未瘢痕子宫破裂患者的数据。
在研究期间，共有 185609 例分娩。其中，有 67 例发生未瘢痕子宫破裂。初产妇中无破裂报告。60 例（89.6%）患者的破裂发生在峡部，7 例（10.4%）患者发生在子宫底部。38 例（56.7%）患者行全子宫或次全子宫切除术，29 例（43.3%）患者行子宫破裂修补术。10 例患者在修补后再次妊娠。其中，8 例有子宫峡部破裂史的患者在 36-37 周时经择期剖宫产成功分娩，2 例分别在 33 周和 34 周时再次破裂。这两名患者均有子宫底部破裂史，两次妊娠的间隔分别为 9 个月和 11 个月。
未瘢痕妊娠子宫破裂的发生率为每 2770 例分娩一例。由于发病率高，超过一半的破裂病例需要行子宫切除术，因此对于经产妇，医生在诱导分娩时应谨慎，因为这是本系列中破裂的主要原因。短的妊娠间隔和子宫底部破裂史可能会增加破裂复发的风险。这些复发的危险因素需要在其他研究中验证。
