经腹与经会阴超声对剖宫产后经产妇子宫下段扫查效果的对比

Comparison of transabdominal and transperineal ultrasound in the scanning of lower uterine segments in parturients after cesarean section

目的探讨经腹与经会阴超声对剖宫产后经产妇子宫下段扫查效果。方法选取2015年4月至2017年6月内蒙古医科大学附属医院收治的236例中晚孕期经产孕妇,根据孕妇上次妊娠分娩方式分组,126例剖宫产孕妇为研究组,110例阴道分娩孕妇为对照组。两组孕妇分别采用经腹与经会阴超声检查,对比不同检查方式对孕妇子宫下段的检查效果。结果研究组和对照组经腹检查达到理想情况率分别为96. 83%和96. 36%,显著高于经会阴检查达到理想情况率(34. 92%,34. 55%)(P <0. 05)。随着孕龄的增加,两组孕妇的子宫前壁下段厚度均逐渐变薄(P <0. 05);在相同孕龄时,对照组孕妇的子宫前壁下段厚度均厚于研究组孕妇(P <0. 05)。在126例研究组孕妇中,只有11. 11%的孕妇能够通过超声检查辨认出瘢痕位置,其余88. 89%则无法确认瘢痕位置。结论超声检查能够较好地反映出孕妇子宫下段情况,但是不能作为预测孕妇阴道试产安全的依据;对剖宫产术后再次妊娠的中晚期孕妇,采取经腹超声检查其子宫下段比经会阴超声检查具有更好的效果。

Objective To investigate the effect of transabdominal and transperineal ultrasound on the scanning of lower uterine segment in parturients after cesarean section. Methods Selected 236 cases of middle - late pregnancy muhigravida in the Affiliated Hospital Inner Mongolia Medical University from April 2015 to June 2017, according to the way of last delivery mode, 126 cases of cesarean section pregnant women were divided into study group, 110 cases of vaginal delivery pregnant women were divided into control group. The two groups of pregnant women were treated by transabdominal and perineal uhrasonography, compared the effect of different screening methods in examining lower uterine segment. Results In the study group and the control group, the ideal rate of transabdominal examination was 96. 83 % and 96. 36 % respectively, which was significantly higher than that of the transperineal examination （34. 92 %, 34. 55 % ） （ P 〈 0. 05 ）. With the gradual increase of gestational age, the thickness of lower anterior wall of the uterus of the two groups gradually became thinner （P 〈 0. 05）. At the same gestational age, the thickness of lower anterior wall of the uterus in the control group was thicker than that of the study group（ P 〈 0. 05 ）. In 126 cases of pregnant women in study group, only 11.11% of pregnant women by ultrasound can identify scar location, the remaining 88. 89 % were unable to confirm the position of the scar. Conclusion Ultrasound can reflect the status of the lower uterine segment well, but can not be used as a basis for predicting the safety of vaginal delivery; for re - pregnant women after cesarean section after the second trimester, transabdominal ultrasonography has better feasibility in examining the lower uterine segment than transperineal ultrasound.