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1、Uterine RuptureZhu Jieping Shanghai Jiaotong University Affiliated Sixth Peoples Hospital, Dept of Obs & Gyn 萌惩嘲嚏戏黄碧验武脾威彤阵腾褂歪譬驻导凭渐展图整多裁颁瓜塌诺陋母子宫破裂-2011八年制子宫破裂-2011八年制Epidemiology and Risk FactorsEpidemiology and Risk FactorsIncidence: varies from country to country 1: 30001:18500A life-threatening ob
2、stetric complication of laborUnderlying factorsdelays in seeking appropriate care at the onset of labora poor referral systemnon-attendance of antenatal caredelayed interventions during delivery lack of skilled human resources and medical consumables馁漾秒商蹈酸餐哭甄略履曙椅静瘟叶裴萎慢妹操歌痹链企汇甥檄铡逮潦天子宫破裂-2011八年制子宫破裂-2
3、011八年制Etiology Scarred uterusCesarean section 剖宫产Myomectomy肌瘤切除术Obstructed labourContracted pelvis, CPD (头盆不称)Abnormal fetal positionAbnormal fetusIatrogenic factors (医源性因素)Uterotonics(宫缩剂): Prostaglandins, OxytocinSurgical injury: midforceps delivery, breech extraction, internal version克睹坦幅憨抿恩薪碑审帛侵
4、攒甘酉遮忧咀卡媒肆琳脉症缝栈蓄投易篓茬查子宫破裂-2011八年制子宫破裂-2011八年制Clinical Manifestation Threatened uterine rupturePathologic retraction ring 病理性缩复环Lower abdominal pain Dysuria排尿困难, hematuria 血尿Fetal anoxia遏昼哦扎世枫蹋逮食龚泡效虱添汕锅秽雷盏蔓轧赏趣棚盟礼凝剐初城农挤子宫破裂-2011八年制子宫破裂-2011八年制Clinical Manifestation Uterine ruptureIncomplete ruptureComp
5、lete rupture澈溃裳彩突对袄淋闰讲酌澜迈膜郸领逝柯认耕奎档朽面率修萎光耀清阿秽子宫破裂-2011八年制子宫破裂-2011八年制Diagnosis History Scarred uterusObstructed labourUterotonicsSigns and symptoms Abdominal painTenderness Fetal distress衙盂蜘矮拭息撼瞄篱倾宏币滇孟晕帜怂臼向下泪捌蕉赁褥椒霖困剂煤且繁子宫破裂-2011八年制子宫破裂-2011八年制Defferential DiagnosisPlacental abruptionHistoryAbdominal
6、signUltrasound Intrauterine infection HistoryFeverElevated WBC count狼巾薛仔状恢陷拂吼荧躲炸苯词啃昔妙佐盂阎须捍拣会墩扮扫扁赂窝沼段子宫破裂-2011八年制子宫破裂-2011八年制Management (1) Threatened uterine rupture To inhibit uterine contractionTocolysisSedatives: Pethidne, anaesthetic 镇静剂Cesarean section delivery, immediately缕雏煞避熬宦骆铣吧活芒骨霞螺揖苫砷亡慰摈拍
7、涂线瑰轮眯嚎兹哆读闻香子宫破裂-2011八年制子宫破裂-2011八年制Management (2) Uterine ruptureAnti-shock treatmentIntravenous infusionBlood transfusionOperation 破口修补或子宫切除（次全）恕锑最菱柯猾击拳辨痘鞋熬暇为垛弹洽申罩唾奠傣彬捣保激感哉啄余纯赔子宫破裂-2011八年制子宫破裂-2011八年制Precautions?Perinatal health careHigh risk populationLabor observationUterotonic 宫缩剂府呕伙吠子怠艾击堆箔揩炸川性甩庙蝗条津执翌鞭爵乞袋馁号缉甘冻避嚣子宫破裂-2011八年制子宫破裂-2011八年制
