子宮破裂-2011八年制.ppt

Uterine Rupture,Zhu Jieping Shanghai Jiaotong University Affiliated Sixth Peoples Hospital, Dept of Obs & Gyn,Epidemiology and Risk Factors,Incidence: varies from country to country 1: 30001:18500 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 consumables,Etiology,Scarred uterus Cesarean section 剖宮產(chǎn) Myomectomy肌瘤切除術(shù) Obstructed labour Contracted pelvis, CPD (頭盆不稱) Abnormal fetal position Abnormal fetus Iatrogenic factors (醫(yī)源性因素) Uterotonics(宮縮劑): Prostaglandins, Oxytocin Surgical injury: midforceps delivery, breech extraction, internal version,Clinical Manifestation,Threatened uterine rupture Pathologic retraction ring 病理性縮復(fù)環(huán) Lower abdominal pain Dysuria排尿困難, hematuria 血尿 Fetal anoxia,Clinical Manifestation,Uterine rupture Incomplete rupture Complete rupture,Diagnosis,History Scarred uterus Obstructed labour Uterotonics Signs and symptoms Abdominal pain Tenderness Fetal distress,Defferential Diagnosis,Placental abruption History Abdominal sign Ultrasound Intrauterine infection History Fever Elevated WBC count,Management (1),Threatened uterine rupture To inhibit uterine contraction Tocolysis Sedatives: Pethidne, anaesthetic 鎮(zhèn)靜劑 Cesarean section delivery, immediately,Management (2),Uterine rupture Anti-shock treatment Intravenous infusion Blood transfusion Operation 破口修補(bǔ)或子宮切除（次全）,Precautio