A Case of Spontaneous Rupture of Non-Scar Uterus during Delivery

doi:10.12280/gjfckx.20201190

Abstract

Abstract:

Uterine rupture refers to the rupture of the body, bottom or lower part of the uterus during delivery or late pregnancy, which directly threatens the life of parturient and fetus, and is a critical obstetric disease. The most common causes are the history of uterine operation and obstructive dystocia, followed by uterine dysplasia, myometrium dysplasia, improper selection of cesarean section incision and vaginal midwifery injury. The main clinical manifestations were abnormal fetal heart, abdominal pain and vaginal bleeding. For patients without high risk factors of uterine rupture and atypical clinical symptoms, uterine rupture is prone to missed diagnosis. A case of spontaneous rupture of non-scar uterus during delivery in the Fourth Hospital of Shijiazhuang was discussed and analyzed to provide help for early identification, early diagnosis and timely treatment of the disease.

Key words: Uterine rupture, Obstetric labor complications, Diagnosis, Case reports

ZHANG Hai-juan, SUN Lu-lu, XU Yan-lei. A Case of Spontaneous Rupture of Non-Scar Uterus during Delivery[J]. Journal of International Obstetrics and Gynecology, 2021, 48(5): 532-534.

Figures/Tables 3

References 6

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时间	诊治经过
1:20	宫口开大3 cm,转入产房待产。
2:10	行分娩镇痛,效果好。产程进展顺利,未应用缩宫素,胎心监测反应型。
5:50	宫口开全。
5:55	主诉宫缩时疼痛难忍,胎心正常,给予安慰,指导用力。
6:00	强直宫缩,胎心波动于90~120次/min,胎头拨露,上台接产。
6:06	顺娩一男婴,体质量2 950 g,Apgar评分10-10-10。
6:15	胎盘自然娩出,阴道出血30 mL。
6:20	情绪烦躁,诉腹痛难忍,查体：血压120/70 mmHg,脉搏100次/min,腹软,子宫收缩强,无明显阴道出血。考虑产后宫缩痛,给予追加分娩镇痛量,改变体位,好转。
8:15	血压120/70 mmHg,脉搏88次/min,子宫收缩好,按压宫底阴道少量出血,产后2 h出血330 mL,转回病区。
13:30	下床活动后突感头晕、心慌,伴上腹部不适,血压110/56 mmHg,脉搏102次/min,血糖11.9 mmol/L,查体：子宫收缩佳,阴道出血少。卧床休息及少量进食后症状明显好转。
15:20	诉上腹部疼痛难忍,查体：脉搏133次/min,血压128/78 mmHg,血氧饱和度98%,呼吸45次/min,痛苦面容,呼吸浅快,腹肌紧张,全腹压痛,上腹部反跳痛,子宫收缩佳,阴道出血少。立即查血常规、凝血功能、离子五项、肝肾功能、淀粉酶和D-二聚体等,请求床旁彩色超声。
15:50	B超示：子宫下段左侧壁肌层显示不清,似可见回声中断宽约2.9 cm。子宫周围包绕子宫可见液性暗区最大直径5.2 cm,右上腹可见液性暗区厚约3.1 cm,脾周可见液性暗区3.2 cm,双侧髂窝均可见液性暗区。考虑子宫破裂,术前准备。
17:00	在全身麻醉下行经腹子宫修补术。术中探查：盆腹腔积血及血块共约500 mL,子宫收缩佳,子宫下段后壁左侧见一纵形破裂口长约3 cm,裂口顶端可见活动性出血,双侧附件未见异常。手术过程顺利,术中出血100 mL,安返病房。
术后5 d	术后恢复顺利,切口Ⅱ/甲愈合。

时间	诊治经过
1:20	宫口开大3 cm,转入产房待产。
2:10	行分娩镇痛,效果好。产程进展顺利,未应用缩宫素,胎心监测反应型。
5:50	宫口开全。
5:55	主诉宫缩时疼痛难忍,胎心正常,给予安慰,指导用力。
6:00	强直宫缩,胎心波动于90~120次/min,胎头拨露,上台接产。
6:06	顺娩一男婴,体质量2 950 g,Apgar评分10-10-10。
6:15	胎盘自然娩出,阴道出血30 mL。
6:20	情绪烦躁,诉腹痛难忍,查体：血压120/70 mmHg,脉搏100次/min,腹软,子宫收缩强,无明显阴道出血。考虑产后宫缩痛,给予追加分娩镇痛量,改变体位,好转。
8:15	血压120/70 mmHg,脉搏88次/min,子宫收缩好,按压宫底阴道少量出血,产后2 h出血330 mL,转回病区。
13:30	下床活动后突感头晕、心慌,伴上腹部不适,血压110/56 mmHg,脉搏102次/min,血糖11.9 mmol/L,查体：子宫收缩佳,阴道出血少。卧床休息及少量进食后症状明显好转。
15:20	诉上腹部疼痛难忍,查体：脉搏133次/min,血压128/78 mmHg,血氧饱和度98%,呼吸45次/min,痛苦面容,呼吸浅快,腹肌紧张,全腹压痛,上腹部反跳痛,子宫收缩佳,阴道出血少。立即查血常规、凝血功能、离子五项、肝肾功能、淀粉酶和D-二聚体等,请求床旁彩色超声。
15:50	B超示：子宫下段左侧壁肌层显示不清,似可见回声中断宽约2.9 cm。子宫周围包绕子宫可见液性暗区最大直径5.2 cm,右上腹可见液性暗区厚约3.1 cm,脾周可见液性暗区3.2 cm,双侧髂窝均可见液性暗区。考虑子宫破裂,术前准备。
17:00	在全身麻醉下行经腹子宫修补术。术中探查：盆腹腔积血及血块共约500 mL,子宫收缩佳,子宫下段后壁左侧见一纵形破裂口长约3 cm,裂口顶端可见活动性出血,双侧附件未见异常。手术过程顺利,术中出血100 mL,安返病房。
术后5 d	术后恢复顺利,切口Ⅱ/甲愈合。

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