瘢痕子宫中期妊娠引产并发子宫破裂的临床分析

Clinical Analysis of Uterine Rupture Complicated by Mid-Term Pregnancy Induction in Scarred Uterus

摘要: 目的：探讨瘢痕子宫中期妊娠引产并发子宫破裂的临床特点及处理策略。方法：回顾性分析1例瘢痕子宫在孕15周 + 3天行引产过程中发生子宫破裂的临床资料，总结其诊疗经过及围手术期处理情况。结果：患者既往2次剖宫产史，合并低置胎盘状态。经依沙吖啶羊膜腔注射、前列腺素类药物及机械性扩张宫颈等治疗后行人工流产钳刮术。术后第3天突发血流动力学不稳定，急诊剖腹探查发现子宫下段瘢痕处破裂，合并胎盘植入。围手术期累计出血量约4000 mL，血红蛋白明显下降，并出现凝血功能异常。因持续活动性出血，行子宫切除术后病情稳定。结论：瘢痕子宫中期妊娠终止过程中存在发生子宫破裂及严重产科出血的风险，瘢痕结构薄弱与胎盘异常可能形成协同作用。加强术前风险评估及围术期动态监测，及时启动严重出血处理流程，对于改善母体预后具有重要意义。

Abstract: Objective: To explore the clinical characteristics and management strategies of uterine rupture during mid-pregnancy induction in scarred uterus. Methods: A retrospective analysis of the clinical data of one case of uterine rupture during induction of labor at 15 weeks and 3 days of pregnancy in a scarred uterus, summarizing its diagnosis and treatment process as well as perioperative management. Results: The patient had a history of two previous cesarean sections and was accompanied by a low-lying placenta. After treatment with amnioscopy injection of ethacridine, prostaglandin drugs, and mechanical cervical dilation, an artificial abortion curettage was performed. On the third day after the operation, hemodynamic instability occurred suddenly, and an emergency laparotomy was performed. It was found that the lower segment of the uterus had a rupture, accompanied by placental implantation. The cumulative blood loss during the perioperative period was approximately 4000 mL, with a significant decrease in hemoglobin and abnormal coagulation function. Due to continuous active bleeding, a hysterectomy was performed, and the condition stabilized. Conclusion: There is a risk of uterine rupture and severe obstetric hemorrhage during mid-pregnancy termination in scarred uterus. The weak scar structure and abnormal placenta may form a synergistic effect. Strengthening preoperative risk assessment and dynamic monitoring during the perioperative period, and promptly initiating the treatment process for severe hemorrhage, are of great significance for improving the prognosis of the mother.