剖宫产切口缺损(CSD)与再次妊娠结局

Cesarean scar defect(CSD)and subsequent pregnancy outcome

目的研究剖宫产切口缺损(cesarean scar defect,CSD)对再次妊娠的影响。方法回顾分析复旦大学附属妇产科医院2013年1月至2018年12月有CSD的瘢痕子宫产妇56例(CSD组)以及同时期无CSD的瘢痕子宫产妇253例(NCSD组)的临床资料及新生儿资料,分析CSD对于再次妊娠的影响。结果CSD组与NCSD组相比较,早产、胎盘粘连或植入、产后出血、先兆子宫破裂或子宫破裂、新生儿apgar评分等妊娠结局差异均无统计学意义(P>0.05),CSD组体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)辅助妊娠者、经期延长者、再次剖宫产术中子宫下段异常者比例高,新生儿体重低(P<0.05),回归分析发现CSD与IVF-ET辅助妊娠不相关。CSD组中有21例孕前或孕早期有测量CSD大小资料,其中有经期延长症状者缺损深度更小(P=0.01),回归分析显示缺损深度与经期延长不相关(P>0.05)。CSD组子宫下段异常者与正常者相比较,两者CSD各径大小及底距浆膜层距离差异均无统计学意义(P>0.05)。结论CSD更易引起经期延长症状,但与缺损深度无关。CSD使再次妊娠剖宫产术中子宫下段异常的发生率增加,但未对再次妊娠结局产生明显不良影响。

Objective To investigate the effect of cesarean scar defect(CSD)on subsequent pregnancy outcome.Method Fifty-six pregnant women with CSD and 253 without CSD who delivered during 2013 and 2018 at Obstetrics and Gynecology Hospital,Fudan University were chosen and divided into two groups.Clinical data of the maternal and the newnatal in the two groups were collected and retrospectively analysed.Results There was no signifcant difference between the two groups in newnatal apgar score and the incidence of preterm birth,placenta adhesion,postpartum hemorrhage or utertine.CSD group had a higher rate of IVF-ET pregnancy,prolonged menstruation and abnormal lower uterine segment during caserean section and the birthweight of newborns was lighter.Data of CSD in 21 women in CSD group were available and depths of CSD were deeper in those who didn’t have prolonged menstruation.There was no significant difference between women with and without abnormal lower uterine segment in the length,width,depth and thickness of residual tissue of CSD.Binary logistic regression analysis indicated that CSD wasn’t correlated with infertility and CSD depth wasn’t correlated with prolonged menstruation.Conclusion CSD could cause prolonged menstruation which wasn’t correlate with CSD depth.CSD increased the incidence of abnormal lower uterine segment.CSD might not have an adverse effect on subsequent pregnancy outcome.