[Current status of uterine rupture: a multi-center survey in China].

Objective: To investigate the current status of uterine rupture in pregnant women in China and analyze the impacts of different surgical histories on the pregnancy outcomes of pregnant women with uterine rupture. Methods: The clinical records and pregnancy outcomes of 84 uterine rupture cases were collected and analyzed retrospectively. All cases came from 21 hospitals of 13 provinces (or municipality) in China, dated from January 1st 2014 to December 31st 2015. The total deliveries were 283 614 during the period. For 84 pregnant women with symptomatic uterine rupture, the impacts of different surgical histories on pregnancy outcomes were compared and the results were statistically analyzed. Results: (1) Totally, 84 cases of uterine rupture were with symptoms and diagnosed. The median age, median gestational age were 32.5 years old (23.0-44.0 years old) and 35.7 weeks (9.3-41.0 weeks), respectively. The incidence of uterine rupture was 0.03% (84/283 614). The proportion of patients with cesarean section history was 66.7% (56/84). The proportion of patients with other gynecological surgery history was 20.2% (17/84). (2)Compared with the group of cesarean section history, the group with other gynecological surgery history had a significant increase in complete uterine rupture (16/17 vs 66.1%, P<0.05). Meanwhile, regarding the massive blood transfusion (red blood cell transfusion≥1 000 ml) in the treatment of uterine rupture, patients with other gynecological surgery history had significant more cases than the group with cesarean section history (9/17 vs 23.2%, P<0.05). There was no statistical difference for the other outcomes. Compared with the patients with cesarean section history, the rate of hysterectomy was higher in the group without major surgery history when uterine rupture happened (4/11 vs 7.1%, P<0.05). The incidence of postpartum hemorrhage significantly increased in patients without major surgery history, compared with those with cesarean section (8/11 vs 28.6%, P<0.05). There were no statistic difference for other outcomes. (3) Patients with uterine rupture in the non-abdominal pain group had a significantly increased risk of massive blood transfusion (5/8 vs 27.6%, P<0.05),and the incidence of neonatal asphyxia and hypoxic ischemic encephalopathy (4/7 vs 22.2%, P<0.05) were significantly increased. There were no significant difference between two groups regarding the other outcomes, such as preoperative diagnosis, complete rupture of uterus, hysterectomy, postpartum hemorrhage, shock, intrauterine fetal death or neonatal death, admission to neonatal ICU. Conclusions: In addition to considering cesarean section history as one of the known risk factors, patients with non-cesarean section uterine surgery history should also be considered. The management of these patients should be strengthened during their pregnancy and delivery. There might be much more dangerous maternal and neonatal outcomes for the patients with uterine rupture who does not have any abdominal pain during pregnancy and delivery. To reduce the incidence of severe complications, uterine rupture should be diagnosed earlier. The early recognition and diagnosis of uterine rupture helps to improve maternal and neonatal outcomes.目的： 了解我国孕妇子宫破裂的现况，并分析既往不同手术史的子宫破裂孕妇的妊娠结局。 方法： 收集2014年1月1日至2015年12月31日我国13个省、直辖市的21家医疗中心（总分娩量为283 614例），84例有症状且术中证实子宫破裂孕妇的临床资料和妊娠结局，分为3组，既往有剖宫产术史组56例（66.7%，56/84），既往有其他妇产科手术史组17例（20.2%，17/84），无重大手术史组11例（13.1%，11/84），分析3组子宫破裂孕妇的妊娠结局。 结果： （1）子宫破裂的总体发生率为0.03%（84/283 614）。84例子宫破裂孕妇的中位年龄为32.5岁（23.0~44.0岁），子宫破裂的中位孕周为35.7周（9.3~41.0周）。（2）既往有其他妇产科手术史组和既往有剖宫产术史组孕妇比较，前者发生子宫完全性破裂者的比例明显增多（分别为16/17、64.3%；P<0.05），发生子宫破裂时大量输血（红细胞输注≥1 000 ml）者的比例明显增多（分别为9/17、23.2%；P<0.05）；余各项母儿结局的差异均无统计学意义（P均>0.05）。无重大手术史组和既往有剖宫产术史组孕妇比较，前者的子宫切除率更高（分别为4/11、7.1%；P<0.05），产后出血的发生率更高（分别为8/11、28.6%，P<0.05），余各项母儿结局的差异均无统计学意义（P均>0.05）。（3）无腹痛与腹痛子宫破裂孕妇比较，前者大量输血的发生率更高（分别为5/8、27.6%，P<0.05），新生儿窒息和缺血缺氧性脑病的发生率明显增加（分别为4/7、22.2%，P<0.05）。 结论： 除了已知的既往有剖宫产术史是子宫破裂的高危因素，既往有其他妇产科手术史的孕妇发生子宫破裂时，可能出现更为严重的并发症，尤其应注意妇科微创手术对子宫肌层的损伤，应加强此类孕妇的管理。妊娠及分娩期无腹痛表现的子宫破裂孕妇，可能出现更加危险的母儿结局，应提高警惕，及早诊断，减少严重并发症的发生。提高子宫破裂早期识别有助于改善母儿结局。.