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的子宫破裂与子宫瘢痕裂开病例，并探讨此类并发症的优化干预方案。
研究方法：本研究为描述性研究，在一家拥有30张床位、服务公共卫生系统使用者的低危产科医院开展。研究通过检索产房登记册，并查阅病历以收集数据，将信息录入预先设计的研究专用表格。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，分析其发病率、与危险因素及诊断相关的特征、与米索前列醇和催产素使用的相关性，并记录观察到的转归情况。
研究结果：本研究周期内，该产科共完成39206例分娩，其中观察到12例子宫破裂病例及16例子宫瘢痕裂开病例。最显著的研究结果为子宫破裂伴随极高的围产儿死亡率，且此类并发症的诊断存在不足；未发现其与米索前列醇或催产素使用存在相关性。
研究结论：若着力提升诊疗团队的诊断能力，则可降低子宫破裂相关不良结局的发生风险。