妊娠晚期瘢痕子宫下段评估对终止妊娠方式选择的临床意义

The Clinical Significance of the Evaluation of the Lower Part of Uterus in the Late Pregnancy Scar for the Choice of the Way of Termination of Pregnancy

目的研究瘢痕子宫再次分娩患者通过瘢痕子宫下段评估对终止妊娠方式选择的意义。方法选取我院于2018年1月至2019年6月产科收治的瘢痕子宫再次分娩患者150例,收集与回顾性分析患者的病案资料,对所有患者均进行妊娠晚期瘢痕子宫下段评估,分析子宫下段评估对终止妊娠方式选择的价值及意义。结果瘢痕子宫再次分娩患者为150例,根据患者前次手术距此次妊娠时间不同,其中<2年有9例,2~5年有102例,>5年有39例。根据彩超提示子宫下段肌层厚度不同,其中厚度<3 mm有86例,厚度>3 mm有64例。根据患者的宫颈评分不同,其中评分<6分有97例,评分>6分有53例。根据胎儿体重评估结果不同,其中体重>3500 g有35例,体重3000~3499 g有82例,体重2500~2999 g有33例。根据此次分娩方式不同,其中剖宫产分娩有138例,阴道分娩有12例。150例患者中,共有3例患者出现先兆子宫破裂,无子宫破裂情况出现。结论瘢痕子宫、巨大儿、胎儿宫内窘迫、胎膜早破、子痫前期、臀位等均会影响患者选择终止妊娠方式。

Objective To study the significance of the evaluation of the lower segment of the scar uterus in the choice of the termination of pregnancy.Methods From January 2018 to June 2019,150 cases of cesarean delivery in our hospital were selected.The data of the patients were collected and analyzed retrospectively.All the patients were evaluated the lower segment of cicatricial uterus in late pregnancy,and the value and significance of the evaluation of the lower segment of uterus for the choice of the way of terminating pregnancy were analyzed.Results According to the time between the previous operation and this pregnancy,there were 9 cases in<2 years,102 cases in 2~5 years and 39 cases in>5 years.According to the color Doppler ultrasound,the thickness of the lower segment of the uterus is different,86 cases are less than 3 mm thick,64 cases are more than 3 mm thick.According to the cervical score of patients,97 cases with score<6 and 53 cases with score>6.According to the results of fetal weight evaluation,there were 35 cases with a body weight of more than 3500 g,82 cases with a body weight of 3000~3499 g and 33 cases with a body weight of 2500~2999 g.According to the different ways of delivery,there were 138 cases of cesarean delivery and 12 cases of vaginal delivery.Among the 150 patients,there were 3 patients with premonitory uterine rupture,no uterine rupture.Conclusion Scarred uterus,macrosomia,fetal distress,premature rupture of membranes,preeclampsia,breech position and so on will affect the choice of termination of pregnancy.