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1、子宫破裂-2011八年制 Still waters run deep.流静水深流静水深,人静心深人静心深 Where there is life, there is hope。有生命必有希望。有生命必有希望 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 refer
2、ral system non-attendance of antenatal care delayed interventions during delivery lack of skilled human resources and medical consumablesEtiology Scarred 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 fact
3、ors (医源性因素) Uterotonics(宫缩剂): Prostaglandins, Oxytocin Surgical injury: midforceps delivery, breech extraction, internal versionClinical 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 anoxiaClinical Manifestation Uterin
4、e rupture Incomplete rupture Complete ruptureDiagnosis History Scarred uterus Obstructed labour Uterotonics Signs and symptoms Abdominal pain Tenderness Fetal distressDefferential Diagnosis Placental abruption History Abdominal sign Ultrasound Intrauterine infection History Fever Elevated WBC countM
5、anagement (1) Threatened uterine rupture To inhibit uterine contraction Tocolysis Sedatives: Pethidne, anaesthetic 镇静剂 Cesarean section delivery, immediatelyManagement (2) Uterine rupture Anti-shock treatment Intravenous infusion Blood transfusion Operation 破口修补或子宫切除（次全）Precautions? Perinatal health care High risk population Labor observation Uterotonic 宫缩剂