目的 探讨完全性子宫破裂的原因、临床特点及常见危险因素，减少子宫破裂对母儿结局的影响。方法 回顾性分析2016年1月至2023年8月河南省辖区内136例孕晚期完全性子宫破裂孕妇的破裂原因、临床特点、风险因素及母儿结局。结果 （1）子宫破裂的原因主要是剖宫产术后瘢痕子宫和宫腔操作史，分别占79.41%和13.24%。（2）子宫破裂的主要症状有腹痛、胎心监护异常和阴道流血，其中腹痛发生率为77.94%，胎心监护异常发生率为34.56%，阴道流血发生率为21.32%。（3）妊娠结局：136例子宫破裂的孕妇中，83例结局良好，53例发生了不良妊娠结局，其中产后出血44例（32.35%）、大量输血29例（21.32%）、子宫切除14例（10.29%）、无孕妇死亡者。孕产妇不良妊娠结局与孕次（OR=2.13，95% CI 1.08~4.20，P=0.029）、子宫破裂的长度（OR=1.21，95% CI 1.09~1.34，P<0.001）、子宫破裂部位（OR=4.19，95%CI 1.32~13.29，P=0.015）有关。（4）围产儿结局：共纳入围产儿133例，不良围产儿结局74例，其中早产42例、新生儿窒息34例、11例发生胎死宫内、13例新生儿死亡，围产儿死亡率为18.05%。围产儿不良结局与孕周（OR=0.51，95%CI 0.36~0.70，P<0.001）、子宫破裂长度（OR=1.16，95%CI 1.04~1.33，P=0.031）、胎心监护异常（OR=7.16，95%CI 1.88~27.32，P=0.004）有关。结论 瘢痕子宫再妊娠者，妊娠晚期出现持续性腹痛症状及分娩期出现胎心监护异常及阴道流血均应警惕子宫破裂可能。瘢痕子宫是子宫破裂的主要危险因素。子宫破裂长度是孕产妇不良妊娠结局的危险因素。子宫破裂长度、胎心监护异常是围产儿不良结局的危险因素。

Objective To analyze the causes，clinical features and common risk factors of complete uterine rupture and to reduce the impact of uterine rupture on maternal and fetal outcomes. Methods A total of 136 patients with complete uterine rupture in late pregnancy from various regions of Henan Province between January 2016 and August 2023 were retrospectively analyzed for the causes of rupture，clinical characteristics，risk factors，and maternal and infant outcomes. Results （1）The causes of uterine rupture were mainly scarred uterus after cesarean section and history of uterine operation，which accounted for 79.41% and 13.24%，respectively.（2） The main symptoms of uterine rupture were abdominal pain，abnormal fetal heartbeat，and vaginal bleeding，among which the incidence of abdominal pain was 77.94%，fetal heartbeat abnormality was 34.56%，and vaginal bleeding accounted for 21.32%.（3） Maternal and fetal outcome：136 cases of uterine rupture，83 cases had a good outcome，53 cases had an adverse pregnancy outcome，and the incidence of postpartum hemorrhage was 32.35%，of which the incidence of massive blood transfusion was 29 cases（21.32%），and hysterectomy was 14 cases，with an incidence of 10.29%. There were 0 maternal deaths. Maternal adverse pregnancy outcomes were associated with gravidity（OR=2.13，95% CI 1.08-4.20，P=0.029），and the length of uterine rupture （OR=1.21，95% CI 1.09-1.34，P<0.001），and the site of uterine rupture （OR=4.19，95% CI 1.32-13.29，P=0.015）.（4） perinatal outcomes：133 cases of perinatal cases were included in this study，74 cases of adverse pregnancy outcomes，preterm labor 42 cases，34 cases of neonatal asphyxia，11 cases of intrauterine fetal death，13 cases of neonatal death，and the perinatal mortality rate was 18.05%. Adverse perinatal outcomes were associated with gestational week（OR=0.51，95%CI 0.36-0.70，P<0.001），and length of uterine rupture （OR=1.16，95% CI 1.04-1.33，P=0.031），and abnormal fetal cardiac monitoring （OR=7.16，95% CI 1.88-27.32，P=0.004）. Conclusions In those with keloid uterus re-pregnancy，symptoms of persistent abdominal pain in late pregnancy and abnormal fetal heartbeat and vaginal bleeding during labor should be alerted to the possibility of uterine rupture. Scarred uterus is a major risk factor for uterine rupture. Length of uterine rupture is a risk factor for adverse maternal outcomes. Length of uterine rupture and abnormal fetal cardiac monitoring are risk factors for adverse perinatal outcomes.