剖宫产再孕的妇女孕期B超监测下剖宫产瘢痕形态学改变

Changes in Caesarean Section Scar Dimensions during Pregnancy

目的:通过B超监测评价剖宫产再孕的孕妇在整个妊娠过程中剖宫产瘢痕处的形态改变,并评价最后的分娩结局。方法:应用阴道超声观察320例有剖宫产史并再次妊娠的妇女怀孕11～13周、19～21周以及32～34周时剖宫产瘢痕的变化,主要测量剖宫产瘢痕处子宫肌层的厚度变化。结果:在320例孕妇中,284例发现剖宫产瘢痕的宽度、长度及厚度均发生改变,比例达到88.7%,瘢痕的长度和宽度明显增大,瘢痕的厚度明显变薄。2例孕妇因剖宫产瘢痕处子宫肌层发生破裂而终止妊娠,这2例病例,B超监测瘢痕处子宫肌层厚度为0.5mm,整个孕期减少了2.7mm、2.5mm。结论:通过观察,建立了相关的B超参考数据,并证明了剖宫产瘢痕在下一次妊娠中会发生形态学上的改变。菲薄的瘢痕处肌层厚度以及该处厚度的快速减少是剖宫产瘢痕破裂的先兆,在剖宫产再孕产妇的孕期监测过程中,瘢痕处肌层厚度的快速改变是提示剖宫产瘢痕破裂的潜在预警信号。这对防止剖宫产再孕的孕妇发生子宫破裂具有重要的意义。

Objective： To describe the changes in caesarean section scars （ CSS ） dimensions during pregnancy and obstetric variables to subsequent changes in scar features and the final pregnancy outcome. Method： In this prospective observational study, the CSS of 320 consecutive pregnant women were examined by transvaginal sonography （TVS）at 11-13, 19-21 and 32-34 weeks gestation. Visible scars consisited of hypoechoic shadow and residual myometrial thickness （ RMT ） segments. Analyses were carried out using SPSS 17. Result： The scar was visible in 284/320 cases （ 88.7% ） . For both scar segments, the larger the initial scar size, the more the scar decreased in size during pregnancy. Two cases of uterine scar rupture were confirmed, these had a mean RMT of 0.5 mm and average decrease in RMT of 2.6 mm over the course of pregnancy. Conclusion： The study establishes reference data and confirms that CSS changes in dimension throughout pregnancy. Scar rupture is associated with a amller RMT and greater decrease in RMT during pregnancy. The absolute value and changes seen in CSS have the potential to be tested as predictors of uterine scar rupture.