瘢痕子宫试产结局与分娩间隔及子宫下段厚度的关系

The Relationship between the Outcomes of Trial of Labor and Interdelivery Time and the Thickness of Lower Uterine Segment

目的:探讨剖宫产术后再次妊娠(PAPC)时限与子宫下段厚度的关系,以及行阴道试产的选择。方法:选择2002年1月至2011年12月在暨南大学附属第一医院行阴道试产的83例瘢痕子宫孕妇的临床资料进行回顾性分析,分析分娩间隔时间与子宫下段厚度及试产成功率与孕妇年龄、孕周、分娩间隔、子宫下段厚度、母儿结局等的关系。结果:①分娩间隔≤3年组子宫下段厚度最大(5.75±1.44 mm),显著高于>9年组(3.88±0.71 mm);分娩间隔≤3年的先兆子宫破裂率(21.4%)大于间隔为3年以上者(0);②56例(67.5%)试产成功;先兆子宫破裂3例(11.1%),其两次分娩间隔时间均在3年内,而且分娩前B超检测子宫下段厚度均大于4 mm。③试产成功组和试产失败组孕妇年龄、住院天数、新生儿体重比较,差异均有统计学意义(P<0.05)。有顺产史瘢痕子宫孕妇试产成功率(100%)显著高于无顺产史者(61.4%),差异均有统计学意义(P<0.05)。结论:剖宫产术后3年内子宫下段厚度并非预测先兆子宫破裂的适宜指标;剖宫产前后有阴道分娩史、胎儿体重较轻的孕妇阴道试产成功率高。

Objective：To explore the relationship between the interdelivery time and the thickness of lower uterine segment and the delivery choice in patients with prior cesarean section. Methods： Retrospective anal- ysis of the clinical data of 83 pregnant women with a previous caesarean scar who voluntarily chose trial of la- bor from January 2002 to December 2011 in the first affiliated hospital of Jinan university. The relationships a- mong the success rate of vaginal delivery and maternal age, gestational age,delivery interval,the thickness of lower uterine segment and the outcomes of mothers and fetuses were analyzed. Results （1） The thickness of lower uterine segment in interdelivery time ≤ 3 years group was the thickest,significantly higher than 〉 9 years group（5.75 ±1.44 mm vs 3.88 ±0.71 mm）. The uterine rupture rate in interdelivery time ≤ 3 years group was greater than that in interdelivery time 〉 3 years group （21.4% vs 0）. （2）There were 3 patients with threatened uterine rupture（ 11.1% ） whose interdelivery time was less than 3 years and the thickness of lower uterine segment under ultrasound before delivery was over 4 mm. （3）The differences in maternal age, days of stay,and birth weight between two groups were statistically significant. The rate of successful trial of labor in pregnant women with scarred uterus was significantly higher in pregnant women who had eutocia his- tory than those without（ 100% vs 61.4%, P 〈 0. 05 ）. Conclusions：The thickness of lower uterine segment within interdelivery 3 years was not an appropriate predictive factor of threatened uterine rupture in trial of la- bor. The rate of successful increases if fetal weight was low or the pregnant women had a history of vaginal delivery before or after prior cesarean.