剖宫产后超声瘢痕检查对子宫异常出血的预测研究

The prediction of abnormal uterine bleeding with ultrasonic scar examination after cesarean section

目的探究剖宫产后超声瘢痕检查对子宫异常出血的预测效果。方法选取2017年9月至2018年4月在衢州市人民医院行剖宫产的189例产妇纳入本研究,纳入产妇均接受阴道超声检查,按照是瘢痕缺损情况将其分为瘢痕缺损组(73例)和瘢痕完整组(116例),再按照月经是否正常将瘢痕缺损组产妇分为子宫异常出血组(31例)和月经正常组(42例)。分析比较各组间产妇的超声参数,分析超声参数在预测子宫异常出血发生上的临床价值,并计算AUC值最高的超声参数的灵敏度,特异度和准确度。结果瘢痕缺损组产妇的瘢痕到宫颈内口距离小于瘢痕完组(t=3.555,P=0.001),瘢痕位置位于子宫前位的比例低于瘢痕完整者(χ~2=14.766,P=0.000)。子宫异常出血组产妇的瘢痕缺损长度、宽度、深度均大于月经正常组,剖宫次数高于月经正常组,差异有统计学意义(t=5.226、3.600、3.724、2.286,P=0.000、0.001、0.000、0.025);瘢痕缺损长度、宽度、深度和剖宫产次数4个状态变量的AUC均低于预测变量Y,瘢痕缺损深度的AUC值最接近预测变量Y。结论剖宫产后行超声瘢痕检查有助于准确探查剖宫产宫壁瘢痕缺损位置、形态及大小,对于预测剖宫产术后子宫异常出血具有一定价值。

Objective To assess the prediction of abnormal uterine bleeding with ultrasonic scar examination after cesarean section.Methods From September 2017 to April 2018,189 parturients who underwent cesarean section in our hospital were included in this study.All parturients received transvaginal ultrasonography examination.They were divided into two groups according to the scar type as the scar defect group(73 cases)and the complete scar group(116 cases).Subjects in scar defect group were further divided into abnormal uterine bleeding group(31 cases)and normal menstruation group(42 cases)based on their menstruation normality.The clinical values of ultrasound parameters in predicting abnormal uterine bleeding were evaluated and the sensitivity,specificity and accuracy of ultrasound parameters with the highest AUC value were calculated.Results The distance from the scar to the cervical orifice was significantly shorter in women with purpura scar defect than in women with purpura scar intact(t=3.555,P=0.001),and the percentage of women with scar located in the anterior part of the uterus was significantly lower than that of women with Pura scar intact(χ~2=14.766,P=0.000).The length,width and depth of PCSD in abnormal uterine bleeding group were significantly longer than those in normal menstruation group,and the number of cesarean section was significantly higher(t=5.226,3.600,3.724,2.286,P=0.000,0.001,0.000,0.025).The AUC values of PCSD length,width,depth and number of cesarean section were significantly lower than predictive variable Y,while the AUC value of PCSD depth was the closest to predictive variable Y.Conclusions Ultrasound examination of uterine wall scar after cesarean section is very helpful in the accurate detection of the location,shape and size of uterine wall scar defect.It is of great significance to predict abnormal uterine bleeding after cesarean section.