Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature.

IF 4.3 4区 医学 Q1 OBSTETRICS & GYNECOLOGY Obstetrical & Gynecological Survey Pub Date : 2023-12-01 DOI:10.1097/OGX.0000000000001205
Inshirah Sgayer, Shirin Dabbah, Rola Khamisy Farah, Maya Wolf, Nadine Ashkar, Lior Lowenstein, Marwan Odeh
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Abstract

Importance: Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes.

Objective: To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus.

Evidence acquisition: PubMed was searched for the phrases "uterine rupture," "unscarred," and "spontaneous." Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included.

Results: We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries.

Conclusions and relevance: Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy.

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无痕子宫自发性破裂:文献综述。
重要性:子宫破裂是指子宫各层发生非手术性破裂。大多数子宫破裂发生在有疤痕的情况下,通常继发于之前的剖宫产。无疤痕的子宫破裂非常罕见,而且会对产妇和新生儿造成严重后果:目的:概述有关无瘢痕子宫破裂的潜在诱发因素、临床表现、孕产妇和胎儿结局的文献:获取证据:在 PubMed 上以 "子宫破裂"、"未受疤痕 "和 "自发性 "为关键词进行检索。结果:我们在 79 篇文章中找到了 84 个病例报告:结果:我们在 79 篇文章中找到了 84 个病例报告。产妇的平均年龄为 29.3(SD,5.7)岁;38 名妇女(45.2%)为无子宫。37%的产妇在足月时发生子宫破裂;9.9%的产妇胎龄小于12周。最常见的临床表现是腹痛(77.4%)、低血容量休克症状(36.9%)、胎儿窘迫(31%)和阴道出血(22.6%)。最常见的风险因素是使用子宫收缩药进行引产或催产,以及之前进行过刮宫手术。最常见的破裂部位是子宫体。子宫切除术处理了36.9%的破裂。有四名产妇死亡(4.8%)。围产期死亡率为 50.6%。发展中国家的围产期死亡率高于发达国家:无瘢痕子宫自发性破裂虽然罕见,但会对母亲和胎儿造成严重后果,应纳入妊娠期急腹症的鉴别诊断中。
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来源期刊
CiteScore
2.70
自引率
3.20%
发文量
245
审稿时长
>12 weeks
期刊介绍: ​Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.
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