Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
Department of Gynecology, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
BMC Pregnancy Childbirth. 2022 Feb 1;22(1):91. doi: 10.1186/s12884-022-04415-6.
Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications.
This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were reviewed retrospectively.
A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10000 births. Among the 41 cases, 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all cases, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcomes, such as fetal death. 24 (59.0%) of the ruptures occurred in anterior lower uterine segment. Changes in Fetal heart rate monitoring were the most reliable signs for rupture.
Incidence of uterine rupture in the study area, Shanghai, China was consistent with developed countries. Further improvements in obstetric care and enhanced collaboration with referring health facilities were needed to ensure maternal and perinatal safety.
子宫破裂是一种产科急症，会给产妇带来严重的不良并发症，导致母婴死亡。本研究旨在评估子宫破裂的发生率、与既往子宫手术及剖宫产术后阴道分娩（VBAC）的关系，以及对母婴的影响。
这是一项基于人群的回顾性研究。纳入 2013 年至 2020 年期间在一个中心治疗的所有破裂子宫的孕妇。从医疗记录部门检索其信息并进行回顾性分析。
共纳入 209112 例分娩，发现 41 例子宫破裂。子宫破裂的发生率为 1.96/10000 例分娩。在 41 例病例中，16 例（39.0%）有母婴并发症。无因子宫破裂导致的产妇死亡，而与子宫破裂相关的围产儿死亡为 7.3%。所有病例中，38 例（92.7%）为瘢痕子宫，3 例（7.3%）为非瘢痕子宫。子宫破裂最常见的原因是既往剖宫产术，而有腹腔镜子宫肌瘤切除术史的病例更可能出现胎儿死亡等严重不良结局。24 例（59.0%）破裂发生在前部下段子宫。胎心监护变化是破裂最可靠的征象。
中国上海研究区域的子宫破裂发生率与发达国家一致。需要进一步改善产科护理，并加强与转诊医疗机构的合作，以确保母婴安全。
