剖宫产后阴道分娩子宫破裂早期识别与管理

doi:10.3877/cma.j.issn.2095-3259.2017.01.003

完全性子宫破裂是剖宫产后阴道分娩(vaginal birth after cesarean，VBAC)少见但极为严重的并发症，一旦发生可导致孕产妇及围产儿的不良结局。规范VBAC产程管理、提升产科医生对危急事件处理能力，有助于安全开展VBAC和及早识别子宫破裂的发生，减少VBAC不良母儿预后。

关键词: 剖宫产后阴道分娩, 子宫破裂, 剖宫产术，再

The incidence rate of uterine rupture in vaginal birth after cesarean (VBAC) is low, but uterine rupture in VBAC is a severe complication. Once it occurs, maternal and perinatal adverse outcomes may happen. Standardizing management of VBAC and promoting emergencies processing capacity of obstetrician are helpful to implement VBAC safely and recognize uterine rupture timely. Meanwhile, it will decrease poor prognosis of mother and fetus.

Key words: Vaginal birth after cesarean, Uterine rupture, Cesarean Section, repeat

表1 胎儿电子监护FIGO四级评价系统^[13]

胎监分类	FIGO分级系统	胎心基线	胎监变异或反应性	减速
正常胎监	FIGO 1	110～150 bpm	1.5～25 bpm	1.早期减速
?	?	?	2．增速	2．变异减速(<60 s，减速幅度<60次)
可疑胎监	FIGO 2	1.100～110 bpm	1.>25 bpm	变异减速(<60 s，减速幅度>60次)
?	?	2.150～170 bpm	2．<5 bpm，持续>40 min且无增速	?
?	?	3．短暂胎儿心动过缓(<100 bpm，≤3 min)	?	?
几项"可疑胎监(FIGO 2)"一起出现时可能形成"异常胎监(FIGO 3)"
异常胎监	FIGO 3	1.150～170 bpm，变异减少>170 bpm	1.<5 bpm，持续>60 min	1.变异减速>60 s
?	?	2．持续心动过缓(<100 bpm且持续>3 min)	2．正弦波形	2．反复晚期减速
临终前胎监	FIGO 4	缺乏变异(<2 bpm)及增速，伴或不伴减速或心动过缓

表1 胎儿电子监护FIGO四级评价系统^[13]

胎监分类	FIGO分级系统	胎心基线	胎监变异或反应性	减速
正常胎监	FIGO 1	110～150 bpm	1.5～25 bpm	1.早期减速
?	?	?	2．增速	2．变异减速(<60 s，减速幅度<60次)
可疑胎监	FIGO 2	1.100～110 bpm	1.>25 bpm	变异减速(<60 s，减速幅度>60次)
?	?	2.150～170 bpm	2．<5 bpm，持续>40 min且无增速	?
?	?	3．短暂胎儿心动过缓(<100 bpm，≤3 min)	?	?
几项"可疑胎监(FIGO 2)"一起出现时可能形成"异常胎监(FIGO 3)"
异常胎监	FIGO 3	1.150～170 bpm，变异减少>170 bpm	1.<5 bpm，持续>60 min	1.变异减速>60 s
?	?	2．持续心动过缓(<100 bpm且持续>3 min)	2．正弦波形	2．反复晚期减速
临终前胎监	FIGO 4	缺乏变异(<2 bpm)及增速，伴或不伴减速或心动过缓

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Early identification and management of uterine rupture in vaginal birth after cesarean section

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Early identification and management of uterine rupture in vaginal birth after cesarean section