子宫破裂-2011八年制

nullUterine RuptureUterine RuptureZhu Jieping Shanghai Jiaotong University Affiliated Sixth People's Hospital, Dept of Obs & Gyn Epidemiology and Risk FactorsEpidemiology and Risk FactorsIncidence: varies from country to country 1: 3000~1:18500 A life-threatening obstetric complication of labor Underlying factors delays in seeking appropriate care at the onset of labor a poor referral system non-attendance of antenatal care delayed interventions during delivery lack of skilled human resources and medical consumablesEtiology Etiology Scarred uterus Cesarean section 剖宫产 Myomectomy肌瘤切除术 Obstructed labour Contracted pelvis, CPD (头盆不称) Abnormal fetal position Abnormal fetus Iatrogenic factors (医源性因素) Uterotonics(宫缩剂): Prostaglandins, Oxytocin Surgical injury: midforceps delivery, breech extraction, internal version Clinical Manifestation Clinical Manifestation Threatened uterine rupture Pathologic retraction ring 病理性缩复环 Lower abdominal pain Dysuria排尿困难, hematuria 血尿 Fetal anoxiaClinical Manifestation Clinical Manifestation Uterine rupture Incomplete rupture Complete ruptureDiagnosis Diagnosis History Scarred uterus Obstructed labour Uterotonics … Signs and symptoms Abdominal pain Tenderness Fetal distressDefferential DiagnosisDefferential DiagnosisPlacental abruption History Abdominal sign Ultrasound Intrauterine infection History Fever Elevated WBC countManagement (1) Management (1) Threatened uterine rupture To inhibit uterine contraction Tocolysis Sedatives: Pethidne, anaesthetic 镇静剂 Cesarean section delivery, immediately Management (2) Management (2) Uterine rupture Anti-shock treatment Intravenous infusion Blood transfusion Operation 破口修补或子宫切除（次全）Precautions?Precautions?Perinatal health care High risk population Labor observation Uterotonic 宫缩剂