Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel (affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5155-5160. doi: 10.1080/14767058.2021.1875435. Epub 2021 Mar 10.
Second and early third-trimester uterine rupture in a non-laboring woman is a very rare and life-threatening condition for both mothers and newborns. However, there are scant epidemiologic data on this event.
Literature searches using Medical Subject Headings (MeSH) and non-MeSH terms were conducted in the PubMed/MEDLINE, Google Scholar and Embase databases from 1988 to 2020. Abstracts were reviewed and selected if they reported on uterine rupture in the second and third trimester. Uterine rupture was characterized as a full-thickness uterine wall defect. A total of 80 singleton intrauterine pregnancies between gestational ages of 14 and 34 weeks' gestation were included.
The mean gestational age at diagnosis of uterine rupture was 22.4 ± 5.4 weeks. The associated events in obstetric history for uterine rupture were: ≥1 previous cesarean section (45%; 36/80 of the cases), previous uterine rupture (10%; 8/80), previous classical uterine incision (7.5%; 6/80), myomectomy (25%; 20/80) and congenital uterine malformations (16.3%; 13/80 of the cases). Uterine ruptures were associated with a short IP interval in 13.7% (11/80) and 43.7% (35/80) were associated with abnormal placentation: placenta accreta spectrum (PAS) disorders ( = 26), placenta previa ( = 2) and placenta previa and PAS ( = 7). The rate of related prenatal ultrasound findings was 67.5%. Cesarean hysterectomy was performed in 27% of the cases. Maternal death was reported in 2.5% (2/80). For the neonates delivered ≥24 weeks' gestation ( = 27) peripartum fetal death was reported in 33.3% (9/27).
Midgestational pre-labor spontaneous uterine rupture is not an anecdotal event and may follow the worldwide increasing rate of cesarean sections. Health care providers should be familiar with the associated factors, presenting symptoms and complications of this obstetric emergency.
在非分娩期妇女中，妊娠中期和晚期的子宫破裂是一种非常罕见且对母婴均有生命威胁的情况。然而，目前关于这种情况的流行病学数据很少。
使用医学主题词(MeSH)和非 MeSH 术语在 PubMed/MEDLINE、Google Scholar 和 Embase 数据库中进行了文献检索，检索时间为 1988 年至 2020 年。如果摘要报告了妊娠中期和晚期的子宫破裂，则进行了回顾和选择。子宫破裂的特征为全层子宫壁缺损。共纳入了 80 例妊娠 14 至 34 周的单胎宫内妊娠。
子宫破裂的平均诊断孕周为 22.4±5.4 周。与子宫破裂相关的产科史事件包括：≥1 次剖宫产（45%；80 例病例中有 36 例）、既往子宫破裂（10%；80 例中有 8 例）、既往经典子宫切口（7.5%；80 例中有 6 例）、子宫肌瘤切除术（25%；80 例中有 20 例）和先天性子宫畸形（16.3%；80 例中有 13 例）。13.7%（80 例中有 11 例）的子宫破裂与 IP 间期缩短有关，43.7%（80 例中有 35 例）与异常胎盘有关：胎盘植入谱系疾病（PAS）障碍（ = 26）、前置胎盘（ = 2）和前置胎盘和 PAS（ = 7）。相关产前超声检查结果的发生率为 67.5%。27%的病例行剖宫产子宫切除术。报告了 2.5%（2/80）的产妇死亡。对于分娩≥24 周的新生儿（ = 27），报告了 33.3%（27 例中有 9 例）的围产儿死亡。
妊娠中期非分娩期自发性子宫破裂并非偶发事件，可能与全球剖宫产率的上升有关。医护人员应熟悉这种产科急症的相关因素、临床表现和并发症。
