经腹、经会阴及经阴道联合超声对妊娠晚期瘢痕子宫破裂风险的评估

Evaluation of the risk of uterine rupture caused by scar in late pregnancy by combined transabdominal,perineal and transvaginal ultrasonography

目的探讨经腹、经会阴及经阴道联合超声对妊娠晚期瘢痕子宫破裂风险的评估价值,以期寻找能准确预测子宫先兆破裂或子宫破裂的方法。方法收集2015年1月~2018年4月剖宫产术后再次妊娠的瘢痕子宫孕妇(孕周≥34周) 200例,术前均采用经腹、经会阴及经阴道联合超声扫查,观察子宫下段肌层连续性、厚度等情况;孕妇行剖宫产术后,观察对比术前超声检查结果与术中诊断结果。结果所有病例最后经手术证实21例子宫先兆破裂,经腹法检测出11例子宫先兆破裂,诊断符合率为52.38%;经腹、经会阴及经阴道联合扫查法检测出19例子宫先兆破裂,诊断符合率为90.48%,两种方法预测先兆子宫破裂诊断符合率比较差异有统计学意义(P<0.05)。结论经腹、经会阴及经阴道联合超声扫查能较好的显示子宫切口肌层等情况,提示子宫先兆破裂风险,对临床有较好的指导价值。

Objective To explore the value of combined transabdominal,perineal and transvaginal ultrasonography in assessing the risk of uterine rupture with scar in late pregnancy,in order to find a preoperative method for accurate measurement of uterine threatened rupture or uterine rupture. Methods 200 cases of pregnant women with scar terus（ pregnancy period≥34 weeks） who were pregnant again after caesarean section from January 2015 to April 2018 were collected. The combined transabdominal,perineal and transvaginal ultrasonography was used before operation to observe the continuous thickness of the subuterine muscle layer of these pregnant women. After cesarean section,the preoperative ultrasonographic results were compared with the intraoperative diagnostic results. Results Eventually 21 cases of threatened rupture were confirmed after operation.11 cases of threatened rupture of uterus were detected by abdominal method with the diagnostic coincidence rate of 52.38% while 19 cases of threatened rupture of uterus were detected by abdominal,perineal and vaginal methods,with the diagnostic coincidence rate of 90.48%.The difference between the two methods in predicting the diagnostic coincidence rate of threatened uterine rupture was statistically significant（ P〈0. 05）. Conclusion Combined transabdominal,perineal and transvaginal ultrasonography can better show the myotomy of uterine incision,and indicate the risk of uterine threatened rupture,which is of great clinical value.