Sugai Shunya, Sasabuchi Yusuke, Yasunaga Hideo, Isogai Toshiaki, Yoshihara Kosuke, Nishijima Koji
Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Arch Gynecol Obstet. 2024 Dec;310(6):3131-3138. doi: 10.1007/s00404-024-07762-1. Epub 2024 Oct 11.
To assess and compare the clinical aspects of uterine rupture by dividing the gestational age at uterine rupture occurrence into < 37-week (preterm) and ≥ 37-week (term) groups.
This retrospective cohort study analyzed data from 187 acute-care hospitals across Japan and included patients who experienced uterine rupture. Data were sourced from the Diagnosis Procedure Combination inpatient database, spanning July 2010 to March 2022. The patients' characteristics, in-hospital procedures, and outcomes were compared between those with uterine rupture at < 37 and ≥ 37 weeks of gestation. The main outcomes were hysterectomy, complications, proportion of blood transfusions, and postoperative length of stay.
A total of 298 patients were identified, with 161 in the preterm group and 137 in the term group. Placenta accreta spectrum occurred more frequently in the preterm group than in the term group (18.0% vs. 6.6%, respectively; P = 0.003). Vacuum delivery (19.0% vs. 0.6%, P < 0.001) and uterine fundal pressure (2.9% vs. 0.0%, P = 0.004) were more likely to be applied in the term group. The maternal need for mechanical ventilation (26.3% vs. 12.4%, P = 0.003), the proportion of disseminated intravascular coagulation (40.1% vs. 25.5%, P = 0.009), and the requirement for platelet transfusions (32.8% vs. 15.5%, P < 0.001) were greater in the term. The postoperative hospital stays were also longer in the term group.
This study shows that individual characteristics vary with the gestational age at uterine rupture, and maternal morbidity is notably higher in term compared to preterm ruptures.
通过将子宫破裂发生时的孕周分为<37周（早产）和≥37周（足月）两组，评估和比较子宫破裂的临床情况。
这项回顾性队列研究分析了日本187家急症医院的数据，纳入了经历子宫破裂的患者。数据来源于诊断程序组合住院数据库，时间跨度为2010年7月至2022年3月。比较了孕周<37周和≥37周子宫破裂患者的特征、住院治疗过程及结局。主要结局包括子宫切除术、并发症、输血比例及术后住院时间。
共识别出298例患者，早产组161例，足月组137例。胎盘植入谱系在早产组的发生率高于足月组（分别为18.0%和6.6%；P = 0.003）。足月组更有可能采用真空助产（19.0%对0.6%，P < 0.001）和子宫底按压（2.9%对0.0%，P = 0.004）。足月组产妇机械通气需求（26.3%对12.4%，P = 0.003）以及弥散性血管内凝血比例（40.1%对25.5%，P = 0.009）和血小板输注需求（32.8%对15.5%，P < 0.001）更高。足月组术后住院时间也更长。
本研究表明，子宫破裂时的个体特征随孕周而异，与早产破裂相比，足月破裂时产妇的发病率明显更高。
