Clinical characteristics of complete uterine rupture

doi:10.3877/cma.j.issn.1673-5250.2019.06.006

Objective

To investigate the current status, clinical features and pregnancy outcome of complete uterine rupture in order to guide the clinical practice.

Methods

From January 2006 to December 2018, a total of 106 747 parturients who gave birth in West China Second University Hospital, Sichuan University were selected into this study. The prevalence rate, general clinical data, clinical features and pregnancy outcomes of patients with complete uterine rupture were analyzed. This study was in line with the World Medical Association Declaration of Helsinki revised in 2013.

Results

① The prevalence rate of complete uterine rupture was 0.038% (41/106 747), of which 0.035% (26/73 369) in 2006-2015 and 0.045% (15/33 378) in 2016-2018. ② Among 41 patients with complete uterine rupture, 22 patients (53.7%) had scar uterus and 19 patients (46.3%) had non-scar uterus. The most common clinical symptom was persistent lower abdominal pain (48.7%, 20/41), the most common clinical signs was abdominal and uterine tenderness (58.5%, 24/41), and fetal heart abnormalities was found in 15.0% (3/20) of patients. ③ All the mothers survived and 6 of them developed complications (14.6%). Hysterorrhaphy was performed in 33 cases (80.5%), total hysterectomy or subtotal hysterectomy was performed in 7 cases (17.1%), removal of rudimentary uterine horn was performed in 1 case (2.4%). ④ In 41 cases of complete rupture of uterus, 27 cases (61.0%) were born alive and 16 cases (39.0%) were stillborn. Among 27 live births, 9 (33.3%) were transferred to pediatrics, 10 (37.0%) had neonatal asphyxia, 8 (29.6%) had mild asphyxia, 2 (7.40%) had severe asphyxia, and 17 had good Apgar scores (1 min after birth).

Conclusions

The most common risk factors of complete uterine rupture include scarred uterus, placental accreta and increta, history of hysteroscopic surgery. In pregnant women with high-risk factors of complete uterine rupture, persistent abdominal pain or abnormal fetal heart monitoring should be aware of the possibility of uterine rupture, and prompt surgical treatment can improve maternal and infant outcomes.

Key words: Uterine rupture, Hysterectomy, Residual uterine pregnancy, Scar uterus, Risk factors, Pregnant women

图1 2006-2018年于四川大学华西第二医院住院分娩孕妇完全性子宫破裂患病率折线图

表1 2006-2018年于四川大学华西第二医院住院分娩孕妇完全性子宫破裂患病率

年份(年)	分娩总例数	患病率[例数(%)]
2006	4 058	1(0.025)
2007	5 363	4(0.075)
2008	5 453	1(0.018)
2009	5 272	4(0.076)
2010	6 359	2(0.031)
2011	7 276	3(0.041)
2012	9 267	5(0.054)
2013	8 722	4(0.048)
2014	10 733	1(0.009)
2015	10 866	1(0.009)
2016	11 755	4(0.034)
2017	9 961	7(0.070)
2018	11 662	4(0.034)
合计	106 747	41(0.038)

表1 2006-2018年于四川大学华西第二医院住院分娩孕妇完全性子宫破裂患病率

年份(年)	分娩总例数	患病率[例数(%)]
2006	4 058	1(0.025)
2007	5 363	4(0.075)
2008	5 453	1(0.018)
2009	5 272	4(0.076)
2010	6 359	2(0.031)
2011	7 276	3(0.041)
2012	9 267	5(0.054)
2013	8 722	4(0.048)
2014	10 733	1(0.009)
2015	10 866	1(0.009)
2016	11 755	4(0.034)
2017	9 961	7(0.070)
2018	11 662	4(0.034)
合计	106 747	41(0.038)

表2 本组41例完全性子宫破裂患者的一般临床资料

项目		例数(%)
年龄(岁)		?
?	<35	25(61.0)
?	≥35	16(39.0)
产次(次)		?
?	<3	36(87.8)
?	≥3	5(12.2)
子宫破裂时孕龄(周)		?
?	0～13^＋6	1(2.4)
?	14^＋1～27^＋6	9(22.0)
?	≥28	31(75.6)
胎数		?
?	单胎妊娠	39(95.1)
?	双胎妊娠	2(4.9)
产前检查		?
?	本院	19(46.3)
?	外院及未产检者	22(53.7)

表2 本组41例完全性子宫破裂患者的一般临床资料

项目		例数(%)
年龄(岁)		?
?	<35	25(61.0)
?	≥35	16(39.0)
产次(次)		?
?	<3	36(87.8)
?	≥3	5(12.2)
子宫破裂时孕龄(周)		?
?	0～13^＋6	1(2.4)
?	14^＋1～27^＋6	9(22.0)
?	≥28	31(75.6)
胎数		?
?	单胎妊娠	39(95.1)
?	双胎妊娠	2(4.9)
产前检查		?
?	本院	19(46.3)
?	外院及未产检者	22(53.7)

表3 本组41例完全性子宫破裂患者的临床特征[例数(%)]

临床特征		发生率	临床特征		发生率
子宫手术史		27(65.9)	子宫畸形		4(9.7)
?	剖宫产术分娩术	18(66.7)	?	诱因	?
?	子宫腺肌瘤挖除术	3(13.6)	?	如厕	4(9.8)
?	子宫肌瘤挖除术	1(4.6)	?	腹部撞击史	2(4.9)
?	宫腔黏连松解术	3(11.1)	?	无明显诱因	35(85.4)
?	子宫纵膈切除术	2(7.4)	引产		7(17.1)
人工终止妊娠术史		19(46.3)	?	米非司酮＋米索前列醇	4(57.1)
临床表现		?	?	依沙吖啶	1(14.3)
?	持续性下腹部疼痛	20(48.7)	?	其他	2(28.6)
?	阴道流血	9(22.0)	子宫破裂位置		?
?	其他(如心悸、血压下降等)	7(17.1)	?	原瘢痕处	19(46.3)
?	胎心异常	3(15.0)	?	宫角、宫底部	13(31.7)
?	无	9(22.0)	?	其他	9(22.0)

表3 本组41例完全性子宫破裂患者的临床特征[例数(%)]

临床特征		发生率	临床特征		发生率
子宫手术史		27(65.9)	子宫畸形		4(9.7)
?	剖宫产术分娩术	18(66.7)	?	诱因	?
?	子宫腺肌瘤挖除术	3(13.6)	?	如厕	4(9.8)
?	子宫肌瘤挖除术	1(4.6)	?	腹部撞击史	2(4.9)
?	宫腔黏连松解术	3(11.1)	?	无明显诱因	35(85.4)
?	子宫纵膈切除术	2(7.4)	引产		7(17.1)
人工终止妊娠术史		19(46.3)	?	米非司酮＋米索前列醇	4(57.1)
临床表现		?	?	依沙吖啶	1(14.3)
?	持续性下腹部疼痛	20(48.7)	?	其他	2(28.6)
?	阴道流血	9(22.0)	子宫破裂位置		?
?	其他(如心悸、血压下降等)	7(17.1)	?	原瘢痕处	19(46.3)
?	胎心异常	3(15.0)	?	宫角、宫底部	13(31.7)
?	无	9(22.0)	?	其他	9(22.0)

表4 本组41例完全性子宫破裂患者及其分娩新生儿围生期结局[例数(%)]

围生期结局		发生率	围生期结局		发生率
输血情况		?	胎儿结局		?
?	红细胞	23(56.1)	?	存活	27(61.0)
?	新鲜冰冻血浆	12(29.3)	?	胎死宫内	16(39.0)
?	血小板	3(7.3)	新生儿生后1 min Apgar评分		?
?	纤维蛋白原	2(4.9)	?	良好	17(63.0)
?	冷沉淀	2(4.9)	?	轻度窒息	8(29.6)
?	自体血	1(2.4)	?	重度窒息	2(7.4)
孕产妇并发症		6(14.6)	新生儿结局		?
?	膀胱破裂	2(4.8)	?	自行抱回	2(7.4)
?	DIC	1(2.4)	?	转入新生儿科	9(33.3)
?	肠损伤	1(2.4)	手术方式		?
?	肺炎	1(2.4)	?	子宫修补术	33(80.5)
?	败血症	1(2.4)	?	全子宫切除术或次全子宫切除术	7(17.1)
产妇转入ICU		3(7.3)	?	残角子宫切除术	1(2.4)

表4 本组41例完全性子宫破裂患者及其分娩新生儿围生期结局[例数(%)]

围生期结局		发生率	围生期结局		发生率
输血情况		?	胎儿结局		?
?	红细胞	23(56.1)	?	存活	27(61.0)
?	新鲜冰冻血浆	12(29.3)	?	胎死宫内	16(39.0)
?	血小板	3(7.3)	新生儿生后1 min Apgar评分		?
?	纤维蛋白原	2(4.9)	?	良好	17(63.0)
?	冷沉淀	2(4.9)	?	轻度窒息	8(29.6)
?	自体血	1(2.4)	?	重度窒息	2(7.4)
孕产妇并发症		6(14.6)	新生儿结局		?
?	膀胱破裂	2(4.8)	?	自行抱回	2(7.4)
?	DIC	1(2.4)	?	转入新生儿科	9(33.3)
?	肠损伤	1(2.4)	手术方式		?
?	肺炎	1(2.4)	?	子宫修补术	33(80.5)
?	败血症	1(2.4)	?	全子宫切除术或次全子宫切除术	7(17.1)
产妇转入ICU		3(7.3)	?	残角子宫切除术	1(2.4)

[1]	刘兴会，贺晶，漆洪波. 助产[M]. 北京：人民卫生出版社，2018：333-337.
[2]	Al-Zirqi I, Stray-Pedersen B, Forsén L, et al. Uterine rupture: trends over 40 years [J]. BJOG, 2016, 123(5): 780-787
[3]	Ofir K, Sheiner E, Levy A, et al. Uterine rupture: risk factors and pregnancy outcome [J]. Am J Obstet Gynecol, 2003, 189(4): 1042-1046.
[4]	谢幸，苟文丽. 妇产科学[M]. 8版. 北京：人民卫生出版社，2014: 182-183.
[5]	Vandenberghe G, Bloemenkamp K, Berlage S, et al. The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study [J]. BJOG, 2019, 126(3): 370-381.
[6]	伍绍文，何电，张为远．完全性子宫破裂28例临床分析 [J]. 中国实用妇科与产科杂志，2018，34(10): 1134-1138.
[7]	刘喆，杨慧霞，辛虹，等. 全国多中心子宫破裂现状调查及结局分析[J]. 中华妇产科杂志，2019，54(6): 363-368.
[8]	Al-Zirqi I, Daltveit AK, Forsén L, et al. Risk factors for complete uterine rupture [J]. Am J Obstet Gynecol, 2017, 216(2): 165. e1-e165.e8.
[9]	Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months [J]. Obstet Gynecol, 2010, 115(5): 1003-1006.
[10]	李航，马润玫，屈在卿．剖宫产后阴道试产子宫破裂的危险因素及其早期识别[J]．中华围产医学杂志，2015，18(9)：705-708.
[11]	Eshkoli T, Weintraub AY, Baron J, et al. The significance of a uterine rupture in subsequent births [J]. Arch Gynecol Obstet, 2015, 292(4): 799-803.
[12]	Al Qahtani NH, Al Hajeri F. Pregnancy outcome and fertility after complete uterine rupture: a report of 20 pregnancies and a review of literature [J]. Arch Gynecol Obstet, 2011, 284(5): 1123-1126.
[13]	Claeys J, Hellendoorn I, Hamerlynck T, et al. The risk of uterine rupture after myomectomy: a systematic review of the literature and Meta-analysis [J]. Gynecol Surg, 2014, 11(3): 197-206.
[14]	陆碧露，汪期明. 子宫肌瘤挖出术后的远期妊娠结局分析[J]. 现代妇产科进展，2019，28(8): 631-633.
[15]	Al-Zirqi I, Daltveit AK, Vangen S. Infant outcome after complete uterine rupture [J]. Am J Obstet Gynecol, 2018, 219(1): 109.e1-e109. e8.
[16]	Delecour L, Rudigoz RC, Dubernard G, et al. Pregnancy and delivery after complete uterine rupture [J]. J Gynecol Obstet Hum Reprod, 2018, 47(1): 23-28.
[17]	Sentilhes L, Sergent F, Roman H, et al. Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy [J]. Eur J Obstet Gynecol Reprod Biol, 2005, 120(2): 134-138.
[18]	Hung FY, Wang PT, Weng SL, et al. Placenta percreta presenting as a pinhole uterine rupture and acute abdomen [J]. Taiwan J Obstet Gynecol, 2010, 49(1): 115-116.
[19]	杜红雁，沈丹华，张瑜，等. 体外受精-胚胎移植术后穿透性胎盘致自发性子宫破裂一例[J]. 中国妇产科临床杂志，2012，13(6)：465-466.
[20]	陈汉青，王子莲. 子宫破裂的诊断及处理[J]．中国实用妇科与产科杂志，2016，32(12)：1178-1182.
[21]	Eze JN, Ibekwe PC. Uterine rupture at a secondary hospital in Afikpo, Southeast Nigeria [J]. Singapore Med J, 2010, 51(6): 506-511.
[22]	中华医学会计划生育学分会. 剖宫产术后瘢痕子宫孕妇中期妊娠引产的专家共识 [J]. 中华妇产科杂志，2019，54(6): 381-386.
[23]	Guiliano M, Closset E, Therby D, et al. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery [J]. Eur J Obstet Gynecol Reprod Biol, 2014, 179: 130-134.
[24]	Kawabe A, Wang L, Kikugawa A, et al. Severe abdominal pain exacerbated by fetal movement is an early sign of the onset of uterine rupture [J]. Taiwan J Obstet Gynecol, 2016, 55(5): 721-723.
[25]	池秀玲，余彩茶，滕慧，等. 超声对妊娠子宫破裂的临床诊断与应用价值[J]. 中国妇幼保健，2013，28(26): 4406-4407.
[26]	Holmgren C, Scott JR, Porter TF, et al. Uterine rupture with attempted vaginal birth after cesarean delivery: decision-to-delivery time and neonatal outcome [J]. Obstet Gynecol, 2012, 119(4): 725-731.
[27]	Fogelberg M, Baranov A, Herbst A, et al. Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section [J]. J Matern Fetal Neonatal Med, 2017, 30(17): 2058-2061.
[28]	Soyama H, Miyamoto M, Sasa H, et al. Pregnancy with asymptomatic uterine complete rupture after uterine artery embolization for postpartum hemorrhage [J]. Taiwan J Obstet Gynecol, 2017, 56(4): 538-540.
[29]	Thisted DLA, Mortensen LH, Hvidman L, et al. Operative technique at caesarean delivery and risk of complete uterine rupture in a subsequent trial of labour at term. A registry case-control study [J]. PLoS One, 2017, 12(11): e0187850.
[30]	Diallo MH, Baldé IS, Mamy MN, et al. Uterine rupture: socio-demographic aspects, etiology and therapy at the University Clinic of Gynecology and Obstetrics of the National Donka Hospital in Conakry University Hospital, Guinea [J]. Med Sante Trop, 2017, 27(3): 305-309.
[31]	Sisay Woldeyes W, Amenu D, Segni H. Uterine rupture in pregnancy following fall from a motorcycle: a horrid accident in pregnancy-a case report and review of the literature [J]. Case Rep Obstet Gynecol, 2015, 2015: 715180.
[32]	Markou GA, Muray JM, Poncelet C. Risk factors and symptoms associated with maternal and neonatal complications in women with uterine rupture. A 16 years multicentric experience [J]. Eur J Obstet Gynecol Reprod Biol, 2017, 217: 126-130.
[33]	Zhang J, Chen SF, Luo YE. Asymptomatic spontaneous complete uterine rupture in a term pregnancy after uterine packing during previous caesarean section: a case report [J]. Clin Exp Obstet Gynecol, 2014, 41(5): 597-598.
[34]	Colmorn LB, Petersen KB, Jakobsson M, et al. The Nordic Obstetric Surveillance Study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery [J]. Acta Obstet Gynecol Scand, 2015, 94(7): 734-744.
[35]	Zhang J, Chen SF, Luo YE. Asymptomatic spontaneous complete uterine rupture in a term pregnancy after uterine packing during previous caesarean section: a case report [J]. Clin Exp Obstet Gynecol, 2014, 41(5): 597-598.
[36]	Ogawa M, Sugawara T, Sato A, et al. Distinctive ultrasonographic finding of complete uterine rupture in early mid-trimester [J]. J Med Ultrason (2001), 2011, 38(2): 93-95.

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