子宮破裂子宮破裂 Uterine RuptureShanghai Jiao Tong UniversityDefinitionoverall uterine rupture rate of 1 in 1,146 pregnancies (0.07%). Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity.pSeparation of the muscular wall of the uteruspusually occurs during laborpoccasionally happen during the later weeks of pregnancy CausesScarred uterus: weak scar after previous operations on the uterus history of cesarean section (VBAC,vaginal birth after c- section) myomectomy excision of a uterine septum previous perforation of uterus(D&C, hysteroscopy, forceps deliveryDystocia: fetal macrosomia, contracted pelvisInduced labor: with oxytocin, with prostaglandinsObstetric management forceps use , Intrauterine manipulation Others: direct uterine trauma (eg, car accident, fall) violence (eg, gunshot)Types Incomplete rupture： overlying visceral peritoneum (uterine serosa) is present complete rupture： full-thickness disruption of the uterine wall u a native, unscarred uterus:u a uterus with a surgical scar: (cesarean delivery, uterine repair, myomectomy) fetal distress (78%) : prolonged, late, or recurrent variable decelerations or fetal bradycardias are often the first and only signs of uterine rupture. diminished baseline uterine pressure; loss of uterine contractility; abdominal pain (5-22%); recession of the presenting fetal part; hemorrhage (11-67%); shock (29-46%);Symptoms and signs1. Rupture of scarsymptom is very slight in incomplete ruptureabdominal pain wrongly attributed to the onset of laborsevere pain and shock occurs in complete (suddenly pain)fetal distressbleeding in vagina2.Spontaneous rupture during obstructed labor prolonged labor violent uterine actions pathologic retraction ring fetal distress a sharp, tearing pain in lower abdomen pulse rapid blood pressure fall fetus may be felt in the abdominal cavityPathologic retraction ring:develops during labor. The ring forms at the junction of the active upper and the relatively passive lower uterine segments.Diagnosisstandard signs and symptomsultrasonography continuous electronic fetal monitoringCTMRI uterine wall :2-3.5mmManagement of the Ruptured UterusThe most critical aspects of treatment:a timely diagnosis ;minimizing the time from the onset of signs and symptoms until the start of definitive surgical therapy; （10-37mins） immediate stabilization of the mother and the delivery of the fetus are imperative.p Type of uterine rupturep Extent of uterine rupturep Degree of hemorrhagep General condition of the motherp Mothers desire for future childbearingTreatment: Prevention:Multiple previous cesarean deliveries;Previous classic midline cesarean delivery;Previous cesarean delivery with an interdelivery interval of less than 2 years;Previous cesarean delivery with either labor induction or augmentation;Previous cesarean delivery in a woman carrying a macrosomic fetus weighing 4000 g;Previous uterine myomectomy accomplished by means of laparoscopy or laparotomy;KeynoteThe causes of the rupture of the uterine?pathologic retraction ring?