超声结合腹部瘢痕压痛对瘢痕子宫再次妊娠分娩方式的预测价值

The predictive value of ultrasonography combined with abdominal scar tenderness on the mode of delivery for re-pregnancy with scarred uterus

目的探讨超声技术结合腹部瘢痕压痛对瘢痕子宫再次妊娠分娩方式的预测价值。方法选取160例瘢痕子宫再次妊娠孕妇,将孕妇按照有无试产意愿分为瘢痕子宫孕妇再次阴道试产(TOLAC)组(48例)与选择性再次剖宫产(ERCS)组(112例)。TOLAC组按最终分娩方式分为再次妊娠阴道分娩(VBAC)组及试产失败后再次剖宫产(RCS)组。均通过超声检查及腹部查体评估瘢痕子宫前壁下段肌层,分析其在选择分娩方式上的指导意义。结果ERCS组112例孕妇经手术探查发现部分肌层局部缺失19例,术前超声提示阳性25例,术前超声联合查体提示阳性22例,超声预测子宫不全破裂的敏感性78%,特异性89%,准确率88%,阳性预测值60%,阴性预测值95%,约登指数0.67。两种方法联合预测子宫不全破裂的敏感性84%,特异性93%,准确率92%,阳性预测值72%,阴性预测值97%,约登指数0.77。TOLAC组按最终分娩方式分为VBAC组17例和RCS组31例,阴道试产成功率为35.4%(17/48)。VBAC组、RCS组、ERCS组均无严重并发症发生。三组产后出血发生情况、新生儿体重及新生儿阿普加评分比较,差异无统计学意义(P>0.05)。结论相比单独使用超声技术,联合腹部瘢痕压痛查体对瘢痕子宫再次妊娠分娩方式可能更具有预测价值。

Objective To explore the predictive value of ultrasound technology combined with abdominal scar tenderness on the mode of re-pregnancy and delivery of scarred uterus.Methods 160 pregnant women with scar uterus were selected,and they were divided into two groups according to whether they were willing to try labor(TOLAC)group(48 cases)and selective re-cesarean section(ERCS)group(112 cases).TOLAC group was divided into vaginal delivery after second pregnancy(VBAC)group and cesarean section after trial delivery failure(RCS)group.Ultrasound and abdominal physical examination were performed to evaluate the muscle layer of the lower anterior wall of the scar uterus and analyze its guiding significance in the selection of delivery mode.Results Among 112 pregnant women in ERCS group,19 cases were found to have partial myometrium partial absence by surgical exploration,25 cases were positive by preoperative ultrasound,and 22 cases were positive by preoperative combined ultrasound examination.The sensitivity specificity and accuracy of ultrasonic prediction of uterine incomplete rupture were 78%,89%,88%,60% positive predictive value and 95% negative predictive value,and the Yodon index was 0.67.The sensitivity,specificity and accuracy were 84%,93%,92%,positive predictive value 72%,negative predictive value 97%,and Jorden index 0.77.TOLAC group was divided into VBAC group(17 cases)and RCS group(31 cases)according to the final delivery mode.The success rate of vaginal trial delivery was 35.4%(17/48).No serious complications occurred in VBAC group,RCS group and ERCS group.There were no significant differences in the incidence of postpartum hemorrhage,neonatal weight and neonatal Apgar score among the three groups(P>0.05).Conclusion Based on the existing data,compared with ultrasound alone,the combined abdominal scar tenderness examination may have more predictive value for the mode of pregnancy and delivery in the scarred uterus.