| Background:Uterine rupture during pregnancy is a serious obstetric complication with low incidence but serious hazards,once it occurs,it can cause serious adverse maternal and child outcomes such as severe bleeding,disseminated intravascular coagulation(DIC),intrauterine distress,fetal death,neonatal death,and even maternal death.In recent years,the incidence of uterine rupture has been increasing year by year.Purpose:By analyzing the clinical data of patients with uterine rupture in second and third trimester and studying the characteristics of their clinical presentation,common risk factors and adverse maternal and fetal outcomes,this study aimed to identify the key points of clinical presentation and preventive management measures of uterine rupture at an early stage in order to reduce the impact of uterine rupture and its complications on mothers and children.Methods:A total of 162 cases of second and third trimester uterine rupture in pregnancy,including 32 cases of complete rupture and 130 cases of incomplete rupture,of which 8 cases were induced in mid-term pregnancy,were collected from Shandong University Qilu Hospital between February 1,2009 and January 31,2022.Their clinical data,clinical symptoms,high-risk factors and maternal and infant outcomes were analyzed.The clinical data were grouped according to gestational week and degree of rupture,and the characteristics of factors associated with uterine rupture were compared.High-risk factors associated with adverse outcomes were identified by univariate and multi-element logistic regression analysis of maternal and infant clinical outcomes.And then compare the relationship between preoperative ultrasound findings and maternal and child clinical outcomes.Finally,cases of severe maternal adverse outcomes,midterm pregnancy induction and non-scarred uterine rupture were described.Result:1.Risk factors:149 cases(92.0%)with previous history of cesarean section,46 cases(28.4%)with history of uterine operations(including hysteroscopic surgery and abortion),4 cases(2.5%)with history of laparoscopic tubectomy;11 cases(6.8%)with combined placental implantation,6 cases(3.7%)with uterine malformation,3 cases(1.9%)with laparoscopic cervical cerclage.One case of adenomyoma(0.6%);8 cases of medically induced or induced labor(4.9%)and 2 cases of obstructed labor(1.2%);107 cases of≥3 pregnancies(66.0%)and 45 cases of≥2 deliveries(27.8%).2.Clinical signs:abdominal pain in 103 cases(63.6%),vaginal bleeding in 25 cases(15.4%),chest tightness and palpitations in 4 cases(2.5%),nausea and vomiting in 2 cases(1.2%)and hematuria in 1 case(0.6%);abnormal fetal heart monitoring in 23 cases(15.3%,23/150);decreased blood pressure in 6 cases(3.7%);preoperative ultrasound suggestive of uterine rupture in 33 cases(20.4%),7 of which had no abdominal pain and other discomfort.3.Week of pregnancy and type of uterine rupture:the proportion of patients with cesarean scar uterus was lower in the<28 weeks group than in the≥28 and<37 weeks group(70.0%vs 88.2%,p=0.007)and the ≥37 weeks group(70.0%vs 94.9%,p<0.001);the proportion of patients with combined placental implantation was higher in the<28 weeks group than in the≥37 weeks group(40.0%vs 2.5%,p<0.001);the proportion of patients with combined uterine malformation was higher in the≥28 and<37 weeks group than in the≥37 weeks group(11.8%vs 0.8%,p=0.009).There were statistically significant differences in history of cesarean delivery(p<0.001),placental implantation(p<0.001),and medically induced or induced labor(p=0.008)between the different degrees of rupture.4.Maternal outcome:Of the 162 cases,150 patients had good pregnancy outcome and the remaining 12 had adverse outcome with bleeding≥2000mL(7.4%),including 9 cases(5.6%)with massive combined transfusion and 5 cases with severe adverse outcome.Serious adverse outcomes included admission to the ICU in 4 cases(2.5%)and death after hysterectomy in 1 case(0.6%).Adverse maternal outcomes were associated with placental implantation(OR=42.184,95%CI 3.042-584.990,p=0.005)and medically induced or induced labor(OR=29.326,95%CI 2.917-294.834,p=0.004).5.Perinatal outcomes:A total of 153 perinatal cases were included in this study,109 had good perinatal outcomes and the remaining 44 had adverse outcomes,including 34(22.2%)preterm births,34(22.2%)NICU admissions,14(9.2%)neonatal distress,3(2.0%)neonatal deaths,and 2(1.3%)intrauterine fetal deaths.Adverse perinatal outcomes were associated with ruptured gestational week(OR=0.236,95%CI 0.137-0.408,p<0.001),ruptured lower uterine segment(OR=0.002,95%CI 0-0.167,p=0.005),ruptured non-cesarean scar uterus(OR=0.012,95%CI 0-0.314,p=0.008),maternal bleeding ≥2000mL(OR=48.028,95%CI 1.287-1791.925,p=0.036)were associated.6.Ultrasound findings:a higher proportion of adverse maternal and perinatal outcomes occur in those with preoperative ultrasound suggestive of uterine rupture compared to those without abnormalities.Conclusion:1.Placenta implantation,medically induced labor,history of uterine operation and obstructed labor are risk factors for the occurrence of maternal adverse outcomes in patients with uterine rupture,with the risk of maternal adverse outcomes for placenta implantation far exceeding other high-risk factors.A history of laparoscopic cervical cerclage and laparoscopic salpingo-oophorectomy is also a contributing factor to uterine rupture.2.Ultrasonography is an important diagnostic basis for detecting patients with asymptomatic uterine rupture.3.Strictly grasp the indications for cesarean section and drug induced labor,and early recognition of early signs of uterine rupture can reduce the occurrence of uterine rupture and the harm it causes. |
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