子宫下段瘢痕厚度与再次分娩方式的选择

Clinical study on the relationship between lower uterine segment sear thickness and choices of delivery pattern of v women with scarred uterus pregnancy

目的探讨妊娠晚期彩超对子宫下段瘢痕厚度检测准确性及其在分娩方式选择的指导意义。方法对2011年1至8月本院住院分娩并具有前次剖官产病史的112例晚期妊娠孕妇行彩超检测子宫下段瘢痕厚度，并将彩超结果与术中实际所见子宫下段瘢痕厚度进行比较，并探讨前次剖宫产史孕妇最佳分娩时机及方式。结果分娩结局为阴道分娩5例，再次剖宫产107例。彩超提示与术中实际所见子宫下段瘢痕厚度相符，子宫下段瘢痕厚度〈3mm者发生子宫破裂风险高，可于孕38周后刮宫产终止妊娠，子宫下段瘢痕厚度≥3mm者发生子宫破裂风险低，可酌情延长孕周甚至经阴道分娩。结论前次剖宫产史孕妇妊娠晚期检测子宫下段瘢痕厚度对选择再次分娩时机及方式具有指导意义。

Objective To explore the accuracy of color doppler ultrasound for detection of lower uterine segment scar thickness and its guiding significance for delivery pattern of women with scarred uterus pregnancy. Methods The thickness of lower uterine segment scar of 112 late pregnancy in our hospital was measured with color doppler ultrasound from January 2011 to August 2011. The results were compared with actual measurement value in operation, and explore the best delivery time and pattern for pregnant women with history of previous cesarean section. Results There were 5 cases of vaginal delivery and 107 cases of cesarean section in total 112 cases. The measurement results were good consistency between color doppler ultrasound and actual values. The pregnant women had high risk of uterus rupture when their lower uterine segment scar thickness were 〈3 cm and selected cesarean section after 38 weeks of gestation; those with scar thickness ≥ 3 mm had little uterus rupture and can continue to have pregnancy, even with selection of vaginal delivery. Conclusion Sonographic lower uterine segment scar thickness of color doppler ultrasound is a strong predictor for choice of delivery time and pattern of women with scarred uterus preguancy.