李丹　张国青　郑连文　徐影

【摘要】子宫破裂是产科严重的并发症，随着剖宫产率的增加，瘢痕子宫已成为子宫破裂最为常见的危险因素，其中以剖宫产术后出现妊娠期子宫破裂最为多见。子宫破裂典型的临床表现为剧烈腹痛、烦躁、血尿、阴道流血等。该文报道1例临床表现不明显的妊娠中晚期胎死宫内、子宫破裂并坏死患者的诊疗过程，提示临床医师应提高对于子宫破裂的早期识别水平，及时给予特殊病史患者个体化治疗，尽量避免此类患者严重不良妊娠结局的发生。

【关键词】子宫破裂;子宫坏死;胎死宫内;不良妊娠结局

【Abstract】Uterine rupture is a serious obstretric complication. With the increase of cesarean section rate， scarred uterus has become the most common risk factor of uterine rupture， especially the uterine rupture during pregnancy after cesarean section. Typical clinical manifestations of uterine rupture are severe abdominal pain， irritability， hematuria and vaginal bleeding， etc. In this article，  the diagnosis and treatment process of one case of fetal death， uterine rupture and necrosis in the middle and late stage of pregnancy without obvious clinical manifestations were reported. The medical staff should improve their early recognition of the occurrence of uterine rupture， timely deliver individualized treatment for patients with special medical history， and avoid the incidence of serious adverse pregnancy outcomes in these patients.

【Key words】Uterine rupture;Uterine necrosis;Fetal death;Adverse pregnancy outcome

子宫破裂是产科严重的并发症，随着剖宫产率的增加，瘢痕子宫已成为子宫破裂最为常见的危险因素，其中以剖宫产术后出现妊娠期子宫破裂最为多见。子宫破裂典型的临床表现为剧烈腹痛、烦躁、血尿、阴道流血等。本文报道1例临床表现不明显的妊娠中晚期胎死宫内、子宫破裂并坏死患者的诊疗过程，以供临床同道参考。

病例资料

一、病史及体格检查

患者女，32歲，已婚，文化程度小学。因不规则阴道流血半个月，发现胎死宫内1 d于2019年11月20日入院。患者在孕期无明显恶心、呕吐等早孕反应，未感胎动。因该患者未觉妊娠迹象，孕期未行常规产前检查。近半个月无明显诱因出现不规则阴道流血，量少，色暗红，伴明显腥臭味，1 d前于当地医院就诊并行妇科彩色多普勒超声（彩超）检查，结果示单死胎、中期妊娠、胎盘前置状态。……