子宫下段肌层厚度对剖宫产术后再次妊娠的时限及相关影响

Correlation analysis of uterine segment thickness and time limits for patients with prior cesarean section

目的：探讨剖宫产术后再次妊娠的时限与子宫下段肌层厚度相关性。方法选取2013年4月至2015年2月本院收治的首次剖宫产术后再次妊娠的80例产妇，按照剖宫产术后与再次妊娠的时间间隔分为 A 组（18例，间隔小于等于3年）、B 组（23例，间隔3～6年）、C 组（27例，间隔7～9年）、D 组（12例，间隔大于9年），比较4组产妇之间的子宫下段肌层厚度及阴道试产成功率，观察因阴道试产失败后行剖宫产的手术情况。结果A 组和 B 组中的子宫下段肌层厚度值分别为（5．93±0．34）mm、（5．45±0．27）mm，高于 C 组（3．24±0．52）mm 和 D 组（2．83±0．56）mm，差异具有统计学意义（P ＜0．05）；A 组和 B 组中分阴道试产成功率分别为88．89％（16／18）、78．26％（18／23），高于 C 组44．44％（12／27）和 D 组33．33％（4／12），差异具有统计学意义（P ＜0．05）；A 组缩宫素用量为（35．34±4．32）mL、术中出血量（256．32±34．21）mL，B 组缩宫素用量（37．09±4．52）mL、术中出血量（260．11±35．53）mL 均低于 C 组和 D 组，差异具有统计学意义（P ＜0．05）；A、B、C 组患者产后出血率分别为0（0／2）、20．00％（1／5）、33．33％（5／15），均低于 D 组87．50％（7／8），差异具有统计学意义（P ＜0．05）。结论产妇的子宫在剖宫产术后7年以下的恢复程度均处于良好状态，子宫下段肌层厚度较高，此时段适合再次妊娠及分娩的选择。

Objective To study the correlation of uterine segment thickness and time limits for patients with prior cesarean section. Methods A total of 80 women with the first pregnancy after cesarean section in our hospital from April 2013 to February 2015,according to the interval of cesarean section and second pregnancy,were divided into group A （18 cases,interval ≤3 years）,group B （23 cases,an in-terval of 3 to 6 years）,group C （27 cases,an interval of 7 to 9 years）,and group D （12 cases,the interval ≥9 years）.The uterine segment thickness and the success rate of vaginal trial production were compared.Surgical failures underwent vaginal trial production due to cesarean section were observed.Results The uterine segment thickness values of group A and group B in were respectively （5.93 ±0.34）mm and （5.45 ±0.27）mm,which were significantly higher than group C （3.24 ±0.52）mm and group D （2.83 ±0.56）mm,the difference was statistically significant （P 〈0.05）.The vaginal trial production success rates of group A and group B were respectively 88.89% （16 /18） and 78.26% （18 /23）,which were significantly higher than group C 44.44% （12 /27）and group D 33.33% （4 /12）（P 〈0.05）.The dos-age of oxytocin of group A was （35.34 ±4.32）mL,blood loss was （256.32 ±34.21）mL, The oxytocin hormone dosage of group B was＆nbsp;（37.09 ±4.52）mL,blood loss was （260.11 ±35.53）mL,which were lower than those in group C and group D （P 〈0.05）.The postpartum hemorrhage rate of group A,group B and group C was respectively 0（0 /2）,20.00% （1 /5）,33.33% （5 /15）lower than group D 87.50%（7 /8）（P 〈0.05）.Conclusion Maternal uterus at cesarean section within 7 years about the degree of recovery are in good condition,the higher uterine segment thickness,this time period is good for subsequent pregnancy and childbirth.