Rupture and dehiscence of uterine scar: cases study at a low-risk maternity in the Brazilian Southeast

PURPOSE: To evaluate the cases of uterine rupture and dehiscence of the uterine scar at a low-risk maternity and to point out possibilities for an improved approach to these complications.METHODS: A descriptive study was conducted at a 30-bed low-risk maternity hospital that provides care to users of the public health system. The investigation was carried out by searching for cases in the delivery room registry book and later reading the medical records in order to obtain the data. The information was inserted on a form previously elaborated for this study. Cases of uterine rupure and dehiscence of the uterine scar diagnosed from 1998 to 2012 were included, with the determination of incidence, aspects related to risk factors and diagnosis, association with the use of misoprostol and oxytocin, and the outcomes observed.RESULTS: A total of 39,206 deliveries were performed in this maternity during the study period, with 12 cases of uterine rupture and 16 cases of dehiscence of uterine scar being observed. The most relevant results were a high perinatal mortality associated with uterine rupture and the unsuccessful diagnosis of this complications. It was not possible to demonstrate an association with the use of misoprostol or oxytocin.CONCLUSION: The adverse outcomes of uterine rupture could be minimized if efforts were directed at improving the diagnostic performance of the assisting teams.

研究目的：评估低危产科病房内子宫破裂（uterine rupture）与子宫瘢痕裂开（dehiscence of the uterine scar）的病例情况，并探讨此类并发症的优化干预路径。
研究方法：本研究为描述性研究，在一所服务于公共医疗系统使用者、拥有30张床位的低危产科医院开展。研究通过检索产房登记册获取病例线索，随后查阅病历以收集完整数据，并将相关信息录入本次研究预先设计的专用表格。本研究纳入1998年至2012年间确诊的子宫破裂及子宫瘢痕裂开病例，分析其发生率、相关危险因素与诊断特征、与米索前列醇（misoprostol）及催产素（oxytocin）使用的关联性，并记录观察到的临床转归。
研究结果：本研究周期内，该产科医院共计完成39,206例分娩，其中观察到12例子宫破裂病例与16例子宫瘢痕裂开病例。本次研究的核心发现包括：子宫破裂伴随较高的围产期死亡率（perinatal mortality），且此类并发症的诊断成功率偏低。未发现子宫破裂或子宫瘢痕裂开与米索前列醇或催产素的使用存在显著关联。
研究结论：若能着力提升诊疗团队的诊断能力，可最大程度降低子宫破裂带来的不良预后。