剖宫产子宫切口非计划延裂：综述与分类系统建议
该叙述性综述综合观察性与干预性研究，评估剖宫产子宫切口非计划延裂的定义、发生率、危险因素及后遗症，并总结预防策略证据。第二产程剖宫产是最强的独立预测因素，延裂与失血增多、输血率升高、手术时间延长及术中损伤风险增加相关。后续子宫破裂证据矛盾且有限，但宫颈或下段创伤可能增加日后自发性早产风险。
要点
- 第二产程剖宫产是子宫切口延裂最强的独立预测因素。
- 延裂与失血增多、输血率升高、手术时间延长及术中损伤风险增加相关。
- 宫颈或下段创伤可能增加后续妊娠自发性早产风险，但证据有限。
核心结论
- 子宫切口非计划延裂是剖宫产常见、致病且被低估的并发症。
- 需要标准化术语、实用的分级系统及更高质量的前瞻性数据。
研究设计与样本
- 叙述性综述，综合评估观察性与干预性研究。
主要发现
- 第二产程剖宫产始终是最强的独立预测因素。
- 延裂与失血增多、输血率升高、手术时间延长及术中损伤风险增加可靠相关。
- 后续子宫破裂证据矛盾且有限。
- 宫颈或下段创伤可能增加日后自发性早产风险。
- 随机与比较研究提示若干分娩方式可能减少延裂。
临床怎么用
- 临床应识别第二产程剖宫产等高危因素并警惕延裂发生。
- 关注延裂相关的失血、输血及术中损伤风险。
局限性
- 后续子宫破裂证据矛盾且有限。
- 缺乏标准化术语与分级系统。
- 需要更高质量前瞻性数据。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Unintentional hysterotomy extensions are common but poorly defined complications of cesarean delivery. This narrative review synthesizes observational and interventional studies evaluating the definition, incidence, risk factors, and sequelae of hysterotomy extensions, and summarizes available evidence on preventative strategies. Cesarean delivery in the second stage of labor consistently emerges as the strongest independent predictor of hysterotomy extensions. Hysterotomy extensions are reliably associated with greater blood loss, higher transfusion rates, longer operative times, and increased risk of intraoperative injury. Evidence regarding subsequent uterine rupture is conflicting and limited. In contrast, several cohorts suggest that cervical or lower-segment trauma may increase the risk of spontaneous preterm birth in later pregnancies. Randomized and comparative studies suggest several delivery methods that may reduce hysterotomy extension. Overall, unintentional hysterotomy extension appears to be a frequent, morbid, and underrecognized complication of cesarean birth for which standardized terminology, a pragmatic grading system, and higher-quality prospective data are needed.
引用
- Burns LP, Wright G, Rausch AC, et al. Unintentional Extensions of the Cesarean Hysterotomy Incision: A Review and Proposed Classification System. Obstet Gynecol. 2026. PMID: 42462249. doi:10.1097/AOG.0000000000006288
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。