瘢痕子宫足月妊娠引产前超声检测宫颈长度及Bishop评分的临床意义

The clinical significance of the cervical length measured by ultrasonic and cervical Bishop score of pregnant women with scarred uterus before labor induction in term pregnancy

目的:探讨瘢痕子宫足月妊娠引产前超声检测宫颈长度(CVL)对引产时间、结局以及分娩方式的临床指导意义。方法:选择本院产科门诊定期产前检查、孕周39~40周、无产兆并要求引产终止妊娠的瘢痕子宫孕妇120例,引产前行阴道超声测量CVL并行宫颈Bishop评分,将CVL≤2.8cm和>2.8cm分组,根据宫颈Bishop采取引产方法,Bishop≥6按引产常规缩宫素引产,<6分组先予Foley导管球囊促宫颈成熟再行缩宫素引产,观察引产效果与分娩方式。结果:CVL≤2.8cm组宫颈Bishop评分(6.03±1.05分)高于CVL>2.8cm组(4.07±1.53分),引产成功率(86.8%)高于>2.8cm组(62.2%),引产至分娩时间(20.4±9.5h)、中转剖宫产率(19.7%)均低于>2.8cm组。宫颈Bishop≥6分孕妇,CVL≤2.8cm者48h内临产率(85.2%)高于CVL>2.8cm者(53.3%)。结论:瘢痕子宫足月妊娠产前超声检测CVL对引产时间、引产结局及分娩方式有一定临床指导意义,联合宫颈Bishop评分预测瘢痕足月妊娠引产阴道分娩效果更佳。

Objective:To explore the clinical significance of the cervical length(CVL) measured by ultrasound on the induction time, pregnancy outcomes, and delivery mode before labor induction in term pregnancy of pregnant women with scarred uterus. Methods: 120 scarred uterus pregnant women without sign in labor who wanted labor induction during the 39-40 th gestational weeks were selected and were given CVL measured by ultrasound and cervical Bishop score evaluated. The women with CVL≤2.8 cm were in group A, and the women with CVL>2.8 cm were in group B. And the women with Bishop score >6 points were given routine oxytocin induced labor, and the women with Bishop score ≤6 points were given promoted cervical ripening by Foley catheter balloon before oxytocin induced labor. The effect of induced labor and delivery mode of all included women were observed. Results: The cervical Bishop score, and the success rate of induced labor of women in group A was 6.03±1.05 points and 86.8%, which were significant higher than those(4.07±1.53 points and 62.2%) of women in group B, but the time from induction to delivery and the rate of conversion to cesarean section of women in group A were 20.4±9.5 h and 19.7%, which were significant lower. The rate of near to give birth within 48 hours of women with Bishop score >6 points in group A was 85.2%, which was significant higher than that(53.3%) of women in group B. Conclusion: The cervical length measured by ultrasonic score of pregnant women with scarred uterus in term pregnancy before labor induction has some certain clinical significance for guiding the induction time, induction outcomes, and delivery mode, which combined with cervical Bishop for guiding vaginal delivery is better.