剖宫产术后瘢痕子宫合并子宫瘢痕憩室对再生育的影响

Effect of scar uterus combined with uterine scar diverticulum after cesarean section on reproduction

目的分析剖宫产术后瘢痕子宫合并子宫瘢痕憩室对再生育的影响。方法选取2015年2月至2018年2月广元市中医医院分娩的82例剖宫产术后瘢痕子宫合并子宫瘢痕憩室孕妇为研究对象(研究组),同期分娩的剖宫产术后瘢痕子宫孕妇64例为对照组,记录孕妇末次超声子宫下段肌层厚度、Apgar评分、新生儿窒息、孕周、产后大出血、剖宫产情况等指标,分析子宫下段异常因素。结果研究组孕妇再次剖宫产80例,经阴道成功生产2例,再次剖宫产率97.56%,对照组孕妇再次剖宫产62例,经阴道成功生产2例,再次剖宫产率96.88%(P>0.05);研究组孕妇末次超声子宫下段肌层厚度和妊娠天数均小于对照组孕妇,子宫下段异常率高于对照组孕妇,差异均有统计学意义(P<0.05);急诊手术率、新生儿窒息率、产后大出血率比较,差异无统计学意义(P>0.05);研究组孕妇孕周>37周、34～36^(+6)周、<34周再次剖宫产率分别为86.25%、8.75%、3.75%,对照组孕妇相同孕周再次剖宫产率为67.74%、22.58%、9.68%,差异有统计学意义(P<0.05);大憩室组和小憩室组孕妇手术中子宫下段异常率分别为33.33%、19.51%,均高于对照组孕妇(12.90%)(P<0.05);憩室类型和子宫下段肌层厚度为子宫下段异常的危险因素。结论剖宫产术后瘢痕子宫合并子宫瘢痕憩室患者较单纯的瘢痕子宫患者再妊娠时子宫下段异常发生率高,妊娠时间短,再次剖宫产率高。

Objective To discuss effect of scar uterus combined with uterine scar diverticulum on production after cesarean section.Methods A total of 82 pregnant women with scar uterus combined with uterine scar diverticulum after cesarean section from February 2015 to February 2018 in Guangyuan Traditional Chinese Medicine Hospital were selected as study subjects(study group),64 cases of cicatricial uterus after cesarean section in the same period were selected as the control group.The thickness of the last ultrasound of the lower uterine segment of the uterus,Apgar score,neonatal asphyxia,gestational age,postpartum hemorrhage,cesarean section and other indicators were recorded to analyze the abnormal factors of the lower uterus.Results There were 80 cases of cesarean section in the study group,2 cases of successful vaginal production,97.56%of cesarean section again.62 cases of cesarean section in the control group,2 cases of successful vaginal production and 96.88%of cesarean section(P>0.05).The thickness of subuterine segment and the number of pregnancy days in the study group were less than those of the control group,the abnormal rate of subuterine segment was higher than that of the control group,the differences were statistically significant(P<0.05).There was no significant difference in emergency operation rate,neonatal asphyxia rate and postpartum hemorrhage rate(P>0.05).The resection rate of pregnant women after 37 weeks,34~36+6 weeks and less than 34 weeks in the study group was 86.25%,8.75%and 3.75%,respectively.The difference was statistically significant compared with the rate of 67.74%,22.58%and 9.68% of the control group at same gestational weeks(P<0.05).The abnormal rate of subuterine segment in the large diverticulum group and the small diverticulum group was 33.33%and 19.51%,respectively,which were higher than those in the control group(12.90%)(P<0.05).The diverticulum type and the thickness of the lower uterine muscle layer were risk factors for abnormalities in the lower uterus.Conclusion After cesarean section,the patients with scar uterus combined with uterine cicatricial diverticulum have higher incidence of abnormal subuterine segment,shorter pregnancy time and high rate of cesarean section than those with simple scar uterus.