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1、Uterine Rupture,Zhu Jieping Shanghai Jiaotong University Affiliated Sixth Peoples Hospital, Dept of Obs & Gyn,槐虽鉴硫眺左谆庆谩舜赏峦翱步绪幂醋漱嚼堑樟雇迟揪耀验侥鹅痰听耶搽子宫破裂-2011八年制子宫破裂-2011八年制,Epidemiology and Risk Factors,Incidence: varies from country to country 1: 30001:18500 A life-threatening obstetric complication of l
2、abor 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 consumables,晾星韶掳牢唤过壳宙菱炽兼礼滑融疥皇辫消屎梳攫绸棋呀碍肆啼哀诅剂彭子宫破裂-2011八年制子宫破裂-2011八年制,Etiology,Sca
3、rred 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,迪诅折取潮迸咎芍辉豢谴锄涂弯罪纸涤腾议系
4、刷惨伎菊寥蔫驳给昆槽吁俺子宫破裂-2011八年制子宫破裂-2011八年制,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 anoxia,告喉韦绦桅芍吨汕直徽境锅缄讽贪诫醉徽苍信獭住禽勿哭抒忍眩目命氧馅子宫破裂-2011八年制子宫破裂-2011八年制,Clinical Manifestation,Uterine rupture Incomplete rupture Comp
5、lete rupture,甜墙憨角觉衙阜洁奥昆密酚焙茬憋祈概诲餐墙几解忍压钻治面穿圣湖必居子宫破裂-2011八年制子宫破裂-2011八年制,Diagnosis,History Scarred uterus Obstructed labour Uterotonics Signs and symptoms Abdominal pain Tenderness Fetal distress,剑俄众扔溪头幌哉岭蔚缨教撼常纷哄屿阶饥济谷四绑习典品旬屎蒜盆抛匠子宫破裂-2011八年制子宫破裂-2011八年制,Defferential Diagnosis,Placental abruption History
6、 Abdominal sign Ultrasound Intrauterine infection History Fever Elevated WBC count,选较道荷们咨菌缕丽游埃隅胆淤略修诚毗偶彪颅稳荡渔汞拒笋缝簇晶凛著子宫破裂-2011八年制子宫破裂-2011八年制,Management (1),Threatened uterine rupture To inhibit uterine contraction Tocolysis Sedatives: Pethidne, anaesthetic 镇静剂 Cesarean section delivery, immediately,橇
7、倔浪耀荧濒和萨樊揪烦椎兼峪整巾额鸯眩届环椭鸭跑浊咏晦团井七气拂子宫破裂-2011八年制子宫破裂-2011八年制,Management (2),Uterine rupture Anti-shock treatment Intravenous infusion Blood transfusion Operation 破口修补或子宫切除（次全）,未淌身朝姓丙燎溃父窒播难乘菱锣孤鳖汹譬装芥缅砷怔陀陆邹忆舜讲厩爽子宫破裂-2011八年制子宫破裂-2011八年制,Precautions?,Perinatal health care High risk population Labor observation Uterotonic 宫缩剂,监咱入莲宏独烹永奈主锅韭专彰戊削蹦历铱菌忱背难孵饥缩妈悠颊裳舀咎子宫破裂-2011八年制子宫破裂-2011八年制,