超声联合检测子宫瘢痕前壁下段厚度对剖宫产再次妊娠女性合理选择分娩方式的指导意义

Clinical significance of ultrasound combined with the measurement of the thickness of the lower part of the anterior wall of the uterine scar in the rational choice of delivery mode for the women of second trimester after cesarean section

目的:评价经腹超声联合经阴道超声检测剖宫产后再次妊娠女性子宫瘢痕前壁下段厚度的临床价值。方法:选取2017年8月至2019年8月诸暨市人民医院收治的妊娠晚期剖宫产后再次妊娠患者180例为研究对象,患者均分别于妊娠32周、34周、36周和38周进行经腹超声检测和经阴道超声检测,比较腹部超声及经阴道超声对于患者子宫下段瘢痕显影率情况,分析不同瘢痕愈合分级患者子宫瘢痕前壁下段厚度差异及随妊娠周期增加的变化情况,跟踪患者分娩结局,统计不同瘢痕愈合分级患者分娩方式及先兆子宫破裂发生情况差异,记录分娩过程中和产后24 h内出血量。结果:腹部超声联合经阴道超声检测对于剖宫后再次妊娠女性子宫瘢痕显影率(100.00%,180/180)显著高于腹部超声(58.89%,106/180)和阴道超声(91.11%,164/180)单独检测水平(χ2=93.147、16.744,均P<0.001);各瘢痕愈合分级患者不同妊娠周期的子宫瘢痕前壁下段厚度差异均有统计学意义(F=35.716~69.247,均P<0.001),各瘢痕愈合分级组组内不同妊娠周期之间的子宫瘢痕前壁下段厚度差异均有统计学意义(F=15.965~24.361,均P<0.001),各组患者子宫瘢痕前壁下段厚度超声检测数值均随妊娠周期的延长而降低(t=5.726~18.051,均P<0.001);各瘢痕愈合分级患者分娩方式及先兆子宫破裂发生率差异均有统计学意义(χ2=39.669、8.312,均P<0.001);各瘢痕愈合分级患者组之间分娩过程中出血量及产后24 h内出血量差异均有统计学意义(F=19.635、27.174,均P<0.001)。结论:腹部超声联合经阴道超声检测可提高子宫瘢痕显影率,检测子宫瘢痕前壁下段厚度有助于指导剖宫后再次妊娠女性选择合理分娩方式,并指导医师及时采取预防分娩风险的措施。

Objective:To evaluate the clinical significance of transabdominal ultrasound combined with transvaginal ultrasound in detecting the thickness of the lower anterior wall of uterine scar in women who are pregnant again after cesarean section.Methods:From August 2017 to August 2019,180 cases of second pregnancy after cesarean section in late pregnancy who admitted to Zhuji People's Hospital were studied.All patients were examined by transabdominal ultrasound and transvaginal ultrasound at 32,34,36 and 38 weeks of gestation respectively.The development rate of scar in the lower segment of uterus was compared between abdominal ultrasound and transvaginal ultrasound.The differences of the thickness of the lower segment of the anterior wall of the uterus in patients with different scar healing grades and the change with the increase of gestation cycle were analyzed.The delivery outcome of the patients was followed up and the statistics was made.The differences of delivery mode and the occurrence of precursory uterine rupture was recorded in different scar healing grades.Results:The uterine scar development rate in women who were pregnant again after cesarean section of abdominal ultrasound combined with transvaginal ultrasound(100.00%,180/180)was significantly higher than that of abdominal ultrasound(58.89%,106/180)and vaginal ultrasound(91.11%,164/180)alone(χ2=93.147,16.744,all P<0.001).The difference of the thickness of the lower anterior wall was statistically significant(F=35.716-69.247,all P<0.001).The difference of the thickness of the lower anterior wall of the uterine scar between different gestational periods was statistically significant(F=15.965-24.361,all P<0.001).There were statistically significant differences in delivery mode and incidence of threatened uterine rupture between the groups with different scar healing grades(χ2=39.669,8.312,all P<0.001).There were statistically significant differences in the amount of bleeding during delivery and within 24 h after delivery between the groups with different scar healing grades(F=19.635,27.174,all P<0.001).Conclusion:Abdominal ultrasound combined with transvaginal ultrasound can improve the development rate of uterine scar.Detection of the thickness of the lower part of the anterior wall of uterine scar is helpful to guide women to choose a reasonable mode of delivery after cesarean section,and guide doctors to take timely measures to prevent the risk of delivery.