彩超检测子宫瘢痕愈合情况对指导再次分娩方式选择及妊娠结局的意义

The significance of detection of healing of uterine scars by color Doppler ultrasonography for guiding the choice of delivery mode and pregnancy outcomes of pregnancy again

目的:探讨彩超检测子宫瘢痕愈合情况对孕妇再次分娩方式选择及妊娠结局评估指导意义。方法:选取2017年6月—2018年6月本院产科分娩的有剖宫产史再次妊娠孕妇128例为观察组,选取同期无剖宫产史孕妇128例为对照组。运用彩色多普勒超声诊断仪观察子宫下段结构,测定子宫下段厚度,评估子宫瘢痕愈合情况。对比两组子宫下段厚度、分娩方式、妊娠结局。结果:观察组经彩超检查子宫瘢痕显示均匀一致型93例(72.7%),鼠尾状25例(19.5%),截断状10例(7.8%);子宫前壁下段厚度(2.9±1.4 mm)低于对照组(4.5±1.1 mm),剖宫产率(50.8%)高于对照组(32.8%)(P<0.05)。观察组中子宫瘢痕愈合良好孕妇的子宫下段厚度(3.6±1.1 mm)高于子宫瘢痕缺陷孕妇(2.1±1.2 mm),子宫瘢痕缺陷孕妇的剖宫产率(91.4%)高于子宫瘢痕愈合良好者(35.5%)(P<0.05),子宫瘢痕愈合良好孕妇的新生儿窒息、子宫不完全破裂、产后出血发生率均低于子宫瘢痕缺陷孕妇(P<0.05)。结论:子宫瘢痕愈合不良会增加子宫破裂、产后出血及新生儿窒息风险,高频彩超检查评估子宫瘢痕愈合情况能够指导临床正确选择分娩方式,降低分娩风险,保障母婴安全。

Objective:To explore the significance of color Doppler ultrasonography for guiding the choice of delivery mode of pregnancy again by detecting the healing of uterine scars and for guiding the evaluation of pregnancy outcomes.Methods:128 pregnant women with a history of cesarean section were selected in observation group,and 128 pregnant women without cesarean section were selected in control group during the same time.The situation of uterine scar healing was evaluated by color Doppler ultrasonography.The thickness of the lower uterine segment,the mode of delivery,and the pregnancy outcomes of women were compared between two groups.Results:In the observation group,there were 93(72.7%)women with homogeneous type uterine scar,25(19.5%)women with tail-shaped type uterine scar,and 10(7.8%)women with truncation type uterine scar.The average thickness of the lower uterine segment of women in the observation group was 2.9±1.4 mm,which was significant lower than that(4.5±1.1 mm)of women in the control group,but the cesarean section rate of women in the observation group was 50.8%,which was significant higher than that(32.8%)of women in the control group(P<0.05).In the observation group,the average thickness of the lower uterine segment of women with uterine scar healing well was 3.6±1.1 mm,which was significant lower than that(2.1±1.2 mm)of women with poor uterine scar healing,but the cesarean section rate of women with uterine scar healing well was 35.5%,which was significant higher than that(91.4%)of women with poor uterine scar healing(P<0.05),and the incidence of neonatal asphyxia,incomplete uterine rupture,and postpartum hemorrhage in pregnant women with uterine scar healing well were also significant lower than those of women with poor uterine scar healing(P<0.05).Conclusion:The poor uterine scar healing can increase the risks of uterine rupture,postpartum hemorrhage,and neonatal asphyxia.The healing of uterine scar of women during pregnancy is assessed by high-frequency color Doppler ultrasonography can guide the correct choice of delivery mode,which can reduce the risk of childbirth and ensure maternal and child safety.