The reason why older mothers are prone to uterine rupture is that as age increases, the elasticity of the uterus becomes worse, and the risk of uterine rupture increases.
Multiple studies have shown that women over 35 years old have an increased risk of uterine rupture in pregnancy. The incidence of uterine rupture in pregnant women over 35 years old is twice that of pregnant women between 25 and 29 years old. Pregnant women with a history of uterine surgery have uterine rupture. The risk of uterine rupture is significantly increased. The more times cesarean section is performed, the greater the risk of uterine rupture.
Cephalopelvic disproportion and Abnormal fetal position are also important causes of uterine rupture. Uterine deformity and excessive uterine expansion are also prone to uterine rupture. Multiple pregnancies and childbirths reduce the elasticity of uterine muscle fibers and slow recovery, which can easily lead to uterine rupture during another pregnancy.
Uterine rupture is one of the serious complications of obstetrics. It has an acute onset and serious condition. If not treated in time, it will endanger the life of mother and child. The main causes of uterine rupture in and are scarred uterus, improper use of oxytocin, obstructive uterine rupture, etc. The incidence of non-scarred uterine rupture during delivery is only 0.006% of pregnancy [1].
Uterine rupture refers to the dehiscence of the uterine body or lower uterine segment during late pregnancy and delivery. Uterine rupture will lead to a series of complications, such as postpartum hemorrhage, fetal distress, severe neonatal asphyxia, death, etc. , will significantly increase the risk of blood transfusion treatment and hysterectomy [3].
According to the degree of rupture, it is divided into complete and incomplete rupture, which is most common during childbirth. Typical uterine rupture manifests as severe abdominal pain, tenderness throughout the abdomen, hematuria , decreased blood pressure, fetal heart disappearance, vaginal bleeding, etc. The diagnosis of typical cases of uterine rupture is not difficult, but if the breach is located on the side wall of the uterus, and the breach is Incomplete uterine rupture that is covered by the placenta and has no obvious symptoms is difficult to diagnose. The pregnant woman in this case had no clinical manifestations such as severe abdominal pain or tenderness throughout the abdomen. During the operation, it was found that the placenta was located at the breach in the left wall of the uterus. Relevant reports have pointed out that the physiological functions of elderly women, especially their fertility, are reduced and they have inherent weaknesses. Repeated expansion and contraction of fibers during childbirth can cause deformation and elongation of uterine muscle fibers. The pressure in the uterine cavity increases during childbirth, causing severe compression of the uterine wall. It may make the weak part of the uterus wall thinner, causing uterus to rupture.
Local adhesions between the omentum, intestinal tube and the left wall of the uterus are common during the operation. The left fallopian tube and mesangium are congested and edematous. Chronic pelvic inflammatory disease has existed in the past. The cause of uterine rupture may be related to the lesions of the uterus itself, such as inflammation. Uterine degeneration is related to uterine cavity infection. The endometrium of and is damaged, uterine fibrosis degenerates, and it is easy to break and cause uterine rupture. Surgical methods for treating uterine rupture include repairing and suturing the uterus, hysterectomy, etc. At this stage, there is still a lack of unified standards. The surgical method for uterine rupture should be based on comprehensive considerations such as the presence of infection, the degree of rupture, and the time of rupture. Life safety is the first factor, and the uterus should be preserved to the maximum extent, because retaining the uterus to continue menstruation is of great physiological and psychological significance to the mother [4].
If the bleeding control is ideal, the rupture time does not exceed 12 hours, the edges of the rupture are neat, there is no obvious infection, and the rupture does not involve the paracervix, cervix, uterine artery and broad ligament, uterine rupture repair can be performed. If If the urine output is small and red, you need to ask a urologist to confirm that there is no damage to the bladder and ureter under a cystoscope. Because the anatomical position of the uterus has changed due to uterine rupture, you should carefully explore whether there is any damage to surrounding organs during the operation, paying special attention to whether there is any damage to the surrounding organs. Ureteral injury to ensure maternal life safety.Since the introduction of the second child policy, the number of older pregnant women has increased year by year, which has become a trend that is difficult to change. For older mothers, the technical level of professionals should be improved, their management should be strengthened, the labor process should be monitored more closely, and the childbirth process should be monitored more closely, and the childbirth process should be alerted to sudden abnormal fetal heartbeats and sudden birth defects. Abnormal fetal heart rate, especially fetal heart rate monitoring showing severe variable decelerations with slight baseline variations, is a reliable sign of the risk of uterine rupture. Early detection of uterine rupture requires early intervention to minimize adverse maternal and perinatal outcomes.
[1] Smith D, Stringer E, Vladutiu CJ, et al. Risk of uterine rupture among women attempting vaginal birth after cesarean with an unknown uterine scar[J]. Am J Obstet Gynecol, 2015, 213(1):80.
[2] Editor-in-chief Xie Xing. Obstetrics and Gynecology [M]. 8th edition. Beijing: People's Medical Publishing House , 2013, (03): 218.
[3] Bai Xiaoxia, Wang Zhengping, Yang Xiaofu, et al. Uterus Clinical analysis of 67 cases of uterine rupture [J]. Chinese Journal of Obstetrics and Gynecology, 2014, 49(5): 331-335.
[4] Sun Huilan. Clinical analysis of 20 cases of uterine rupture during pregnancy [J]. Chinese Health Standards Management, 2014 ,5(20):145-14.
