经阴道超声对剖宫产后再次妊娠早期子宫疤痕处肌层厚度检测的临床价值

摘要

Objective To investigates the clinical value of transvaginal ultrasound in detecting muscle layer thickness of uterine scar in early re-pregnancy after cesarean section.Methods By using transvaginal ultrasound,muscle thickness of uterine scar in early pregnancy were measured to assess the uterine scar healing of 124 secundigravida after cesarean section in our hospital from January 2012 to December 2013.Uterine scar healing degree in early period was assessed and then uterine scar healing after cesarean delivery or vaginal delivery was assessed again.Clinical compliance rates were counted by measuring the scars muscular thickness in early pregnancy as control group.Results In the 124 cases of the study group,113 cases were cesarean delivery,11 cases were spontaneous vaginal delivery.The result of assessing uterine scar healing degree in early pregnancy:32 cases were grade Ⅰ healing,clinical compliance rate was 100％; 68 cases were grade Ⅱ] healing,clinical compliance rate was 94.12％; 24 cases were grade Ⅲ healing,clinical compliance rate was 95.83％; no complete uterine rupture found.In the 50 cases of the control group,class Ⅰ healing compliance rate was 65.38％,class Ⅱhealing compliance rate was 77.27％,class Ⅲ healing compliance rate was 50％.Conclusion The uterine scar healing degree can be assessed with higher accuracy by measuring the thickness of the uterine scar myometrium in early second pregnancy after cesarean.It provides a strong basis for the obstetrician in guiding prenatal care for pregnant women,predicts the risk of uterine rupture in late pregnancy with uterine scar,and suggests the way of delivery,thus reduces the rate of cesarean again.%目的 研究经阴道超声对剖宫产后再次妊娠早期子宫疤痕处肌层厚度检测的临床价值.方法 回顾2012年1月至2013年12月剖宫产后再次妊娠在我院进行产检和分娩的124例孕妇,均经阴道超声对剖宫产术后再次妊娠早期子宫疤痕处肌层厚度进行检测,早期评估子宫疤痕愈合程度,并追踪其晚期剖宫产手术时疤痕愈合程度的评估情况或阴道分娩情况,统计疤痕子宫早期妊娠疤痕处肌层厚度检测评估子宫疤痕愈合程度的临床符合率.并与随机获得的50例疤痕子宫妊娠晚期子宫疤痕处肌层厚度检测来评估子宫疤痕愈合程度的对照组进行对比分析.结果 研究组124例中剖宫产113例,经阴道顺产11例;疤痕子宫妊娠早期子宫疤痕愈合程度评估:Ⅰ级愈合32例,临床符合率100％;Ⅱ级愈合68例,临床符合率94.12％;Ⅲ级愈合24例,临床符合率95.83％,无完全性子宫破裂;随机获得的疤痕子宫妊娠晚期的对照组50例,Ⅰ级愈合符合率65.38％,Ⅱ级愈合符合率77.27％,Ⅲ级愈合符合率50％.结论 剖宫产后再次妊娠早期子宫疤痕处肌层厚度检测能较准确评估子宫疤痕愈合程度,且优于单纯妊娠晚期对子宫疤痕厚度检测评估,为妇产科医生指导孕妇孕期保健、对疤痕子宫晚期妊娠子宫破裂风险的预测和分娩方式的选择提供有力依据,可降低疤痕子宫妊娠再次剖宫产率.