摘要
目的 探究超声检诊在妊娠晚期瘢痕子宫下段肌层厚度对再次妊娠剖宫产时机选择的临床意义。方法 选取2016年10月至2020年10月于本院检诊的118例妊娠晚期瘢痕子宫孕妇作为瘢痕组,另选取同期于本院检诊无子宫手术既往史的117例正常孕妇作为对照组,比较两组孕妇超声检诊子宫下段肌层厚度情况,比较瘢痕子宫不同级别孕妇分娩方式、孕妇术中情况及妊娠结局。结果 随着瘢痕级别升高,孕妇子宫下段肌层厚度呈降低趋势,各级别瘢痕组子宫下段肌层厚度比较差异有统计学意义(P<0.05),且瘢痕组显著低于对照组(P<0.01)。Ⅱ级、Ⅲ级、Ⅳ级瘢痕组孕妇剖宫产率显著高于Ⅰ级瘢痕组与对照组,差异有统计学意义(P<0.01)。瘢痕子宫不同级别孕妇手术时间、术中及产后24 h出血量显著高于对照组(P<0.01);瘢痕组不全子宫破裂、切口愈合不良发生率均显著高于对照组(P<0.01)。随瘢痕子宫等级升高,手术时间、术中及产后24 h出血量、不全子宫破裂、切口愈合不良发生率均呈升高趋势(P<0.01)。随着孕妇瘢痕子宫等级升高,妊娠结局新生儿的轻、重度窒息发生率呈升高趋势(P<0.01)。结论 瘢痕子宫孕妇妊娠晚期子宫下段肌层厚度较低者,应首选剖宫产分娩,超声检诊评估瘢痕子宫孕妇子宫下段肌层厚度,可指导既往剖宫产孕妇选择分娩方式,预防子宫破裂,对提高分娩安全性具有积极的临床意义。
Objective To study the clinical significance of ultrasound in the selection of cesarean section time in the second pregnancy.Methods 118 pregnant women with scar uterus in the third trimester who were examined in our hospital from October 2016 to October 2020 were selected as the scar group,and 117 normal pregnant women who had no previous history of uterine surgery in our hospital during the same period were selected as the control group.The thickness of myometrium of the lower uterine segment was compared between the two groups of pregnant women by ultrasound examination,and the delivery methods,intraoperative conditions and pregnancy outcomes of pregnant women with different grades of scar uterus were compared.Results With the scar grade gradually increased,the myometrium thickness of the lower uterine segment of pregnant women showed a decreasing trend,there was significant difference in the thickness of the lower uterine segment myometrium between the different grades of scar groups(P<0.05),and the scar group was significantly lower than the control group(P<0.01).The cesarean section rate of grade Ⅱ,grade Ⅲ and grade Ⅳ of scar group were significantly higher than that of gradeⅠscar group and control group(P<0.01).The operation time,intraoperative and 24-hour postpartum blood loss of pregnant women with different grades of scar uterus were significantly higher than those of the control group(P<0.01).The incidence of incomplete uterine rupture and poor wound healing in the scar group were significantly higher than those in the control group(P<0.01).The operative time,intraoperative and 24-hour postpartum blood loss,incomplete uterine rupture,and the incidence of poor incision healing all increased with the increase in the grade of the scarred uterus(P<0.01).As the grade of scar uterus increases,the incidence of mild and severe asphyxia in neonates at the end of pregnancy tends to increase(P<0.01).Conclusion Cesarean section should be preferred for the patients with lower uterine myometrium thickness in the third trimester of pregnancy with scar uterus.Ultrasound examination and evaluation of uterine lower myometrium thickness can guide previous cesarean section pregnant women to choose delivery mode,prevent uterine rupture and improve delivery safety,which has very positive clinical significance.
作者
张琳
ZHANG Lin(Color Doppler Ultrasound Room,Haicheng Central Hospital,Anshan,Liaoning,114200,China)
出处
《当代医学》
2022年第8期8-11,共4页
Contemporary Medicine
关键词
超声检诊
瘢痕子宫
剖宫产
子宫下段
分娩方式
Ultrasonic examination
Scarred uterus
Cesarean section
Lower uterine segment
Mode of delivery
