【摘要】目的探讨瘢痕子宫不全破裂的早期诊断、处理及预防。方法2006年1月2009年1月发生瘢痕子宫不全破裂13例,术前临床症状加B超检查确诊,手术从原切口进入宫腔,取出胎儿,修剪原切口周围瘢痕组织,10可吸收线连续缝合浆肌层,再间断包埋缝合切口,术后常规预防感染,加强宫缩治疗;胎盘植入2例尽量取出胎盘,修整切口,活动性出血明显者用10可吸收线“8”字缝扎止血,术后加服米非司酮150 mg/d共3 d。结果母婴均痊愈出院。42 d后来院复查,B超探查8例子宫下段处有线状较强回声,肌层回声均匀,余未发现异常;胎盘植入2例，随防3个月血绒毛膜促性腺激素呈阴性。结论早期B超检查能提高瘢痕子宫不全破裂确诊率,确诊后急诊剖宫产,胎盘部分植入者加服米非司酮并预防感染。
Objective To explore the safety and efficiency of cervical expansion balloon in promoting cervical ripening of cicatrical uter women with full-term pregnancy attempting vaginal delivery. Methods Fifty cases of pregnant women at the third trimester with cicatrical uter admitted to Nanshan District Maternal and Child Health Care Hospital of Shenzhen from July 2015 to March 2016 were retrospectively and randomly collected as the observation group. Another 50 pregnant women at the third trimester with normal uter admitted to the same hospital in the same period were retrospectively and randomly collected as the control group. All the cases had indications for labor induction, and had intention and conditions of vaginal delivery. Cervical expansion balloons were used in the two groups to promote cervical ripening. The effective rate of promoting cervical ripening, the outcomes of delivery and the incidences of adverse outcomes were compared between the two groups. Results The differences in effective rate of promoting cervical ripening and success rate of induced labor of cervical ripening of pregnant women between the observation group (66%, 76%) and the control group (76%, 84%) were not statistically significant (P>0.05). There were no significant differences in the time of birth process, amout of postpartum bleeding, birth immediate Apgar score, neonatal birth weight, and vaginal delivery rate, and the incidences of acute chorioamnionitis and cervical laceration of pregnant women between the two groups (P>0.05). Incomplete uterine rupture occurred in one case in the observation group, while none in the control group; neonatal mild asphyxia occurred in one case in the control group, while none in the observation group; the differences were not statistically significant (P>0.05). No postpartum hemorrhage occurred in the two groups. Conclusions Under the premise of strictly following the indications, cervical expansion balloon can be used in promoting cervical ripening at the third trimester of pregnant women with cicatrical uter attempting vaginal delivery, improve the success of attempting vaginal delivery, reduce the occurrence of reduplicated cesarean section, and not increase the incidence of maternal and fetal adverse outcomes.
Objectives To analyze the risk factors of uterine rupture in pregnancy in Chengdu Women’s and Children’s Central Hospital in recent years. Methods The clinical data of pregnant uterine rupture patients who were hospitalized in Chengdu Women’s and Children’s Central Hospital from January 2011 to December 2017 were collected. The risk factors of uterine rupture in pregnancy were analyzed compared with the maternal delivery during the same period. The SPSS 23.0 software was used for statistical analysis. Results A total of 69 patients with uterine rupture were included, involving 14 cases of complete uterine rupture and 55 cases of incomplete uterine rupture. Compared with the pregnant females who were hospitalized during the same period, the incidence of uterine rupture in patients with scar uterus after cesarean section, history of laparoscopic hysterosalping surgery, placental implantation, twins and uterine malformation was higher, and the difference was statistically significant (P<0.05). Among them, the risk of uterine rupture was greater in the interpregnancy interval (IPI)>24 months after cesarean section in patients with scar uterus. There was no significant difference in the incidence of uterine rupture between the elderly and the multiple pregnant females and the maternal delivery during the same period (P>0.05). Conclusions Scar uterus (postoperative cesarean section), history of laparoscopic hysterosalping surgery, placental implantation, twins, and uterine malformation are possible risk factors for uterine rupture in pregnancy. Among them, patients with scar uterus have a greater risk of uterine rupture with IPI>24 months.