高频超声在剖宫产后瘢痕子宫再次妊娠分娩方式选择中的意义

High frequency ultrasound in the choice of delivery mode of scarred uterus after cesarean section

目的:探讨高频超声在剖宫产后瘢痕子宫再次妊娠分娩方式选择中的意义。方法 :对122例有剖宫产史的孕妇再次妊娠后35周起采用高频探头,观察子宫下段的厚度及结构(其中下段厚度≥3 mm 67例,<3 mm 55例);下段厚度≥3 mm孕妇中32例进行阴道试产;<3 mm适时行再次剖宫产术,于再次剖宫产术中对子宫下段情况进行比较。结果:(1)妊娠晚期瘢痕子宫孕妇子宫下段肌层厚度明显小于无瘢痕子宫孕妇(P<0.05);(2)高频超声显示子宫下段呈"鼠尾状"及"截断状"的病例,子宫不全破裂和瘢痕愈合不良的比例较"均匀一致"组高(χ2=27.99,P<0.05);(3)瘢痕子宫下段厚度≥3 mm且超声呈"均匀一致"孕妇阴道试产率为47.76%,试产成功率为81.25%。结论:通过高频超声检查妊娠晚期瘢痕子宫下段肌层状态,为临床判断是否可以经阴道试产提供重要信息。

Objective： To study association of high frequency ultrasound with the choice of delivery mode of scarred uterus after cesarean section. Methods： The thickness and structure of the lower uterine segment of 122 cases of pregnant women with a history of cesarean section were observed by using high frequency probe after 35 pregnant weeks（67 cases of the thick-ness of lower segment≥3 mm, 55 cases of the thickness of lower segment 〈3 mm）. After communication with pregnant wom-en of the thickness of lower segment ≥3 mm, 32 cases chose vaginal delivery, and 55 cases of the thickness of lower seg-ment〈3 mm chose cesarean section. The conditions of lower uterine segment were compared in cesarean section. Results：The thickness of lower uterine segment of scarred uterus in late trimester of pregnancy was significantly less than that of uterus without scar（P〈0.05）. The incidences of incomplete uterine rupture and poor healing of uterus incision of lower uterine seg-ment appearing in rat caudate and truncation in high frequency ultrasound were significantly higher than that appearing in u-niformity（both P〈0.05）. The rate of vaginal delivery of the thickness of lower uterine segment of scarred uterus ≥3 mm and appearing in uniformity was 47.76%, and the successful rate was 81.25%. Conclusion：The detection of lower uterine segment of scarred uterus by high frequency ultrasound can offer important information for vaginal delivery.