超声测量瘢痕子宫下段肌层厚度对分娩方式和围产儿结局的影响

Relationships between the muscularis thickness of the lower segment of scar uterus of ultrasound measurement and the delivery mode,the outcome of perinatal child

目的:探究不同瘢痕子宫下段肌层厚度对孕妇再次妊娠分娩方式及围产儿结局的影响。方法:选择医院收治的160例有剖宫产史且再次妊娠的孕妇,使用超声诊断仪测量孕妇瘢痕子宫下段肌层厚度,根据瘢痕厚度将其分为Ⅰ级组(72例,厚度>3 mm)和Ⅱ级组(88例,厚度2~3 mm)组。比较两组手术时间、产后24 h出血量、缩宫素用量、总产程以及住院时间围术期指标;比较两组新生儿出生体重、新生儿阿普加(Apgar)评分、新生儿窒息发生率及异常胎盘情况;比较两组阴道试产成功率和转剖宫产情况;观察并记录两组术后并发症发生情况。结果:Ⅰ级组产后24 h出血量和缩宫素用量均低于Ⅱ级组,差异有统计学意义(t=3.221,t=16.056;P<0.05);两组手术时间、总产程及住院时间,以及新生儿的出生体重、Apgar评分、窒息、胎盘早剥及胎盘粘连发生率均无明显差异。Ⅰ级组阴道分娩成功率高于Ⅱ级组,且剖宫产率较低,其分娩方式比较差异有统计学意义(x^(2)=24.115,P<0.05),术后并发症发生率均低于Ⅱ级组,差异有统计学意义(x^(2)=4.099,P<0.05)。结论:不同瘢痕子宫下段肌层厚度对分娩方式和围产儿结局具有不同程度的影响,瘢痕子宫下段肌层厚度≤3 mm的孕妇再次妊娠后阴道试产成功率较低,还可能提升前置胎盘发生率和术后并发症发生率,此类孕妇阴道试产转剖宫产的风险较高,应提前做好准备,降低子宫破裂风险。

Objective:To explore the effect of muscularis thicknesses of the lower segment of different scar uteruses on the delivery modes and outcomes of perinatal children of pregnant women with re-pregnancy.Methods:A total of 160 pregnant women with history of cesarean section and re-pregnancy who admitted to hospital were selected,and the muscularis thicknesses of the lower segments of scar uteruses of pregnant women were measured by ultrasound diagnostic instrument.According to the different scar thicknesses,they were divided into grade I group(72 cases,thickness>3mm)and gradeⅡgroup(88 cases,thickness range was between 2mm and 3mm)group.The operation time,bleeding volume of postpartum 24-hour,oxytocin dosage,total labor process and the perioperative indicators during hospitalization time were compared between the two groups,as well as the birth weight of newborn,Apgar score of newborn,incidence of neonatal asphyxia and abnormal placenta of two groups.In addition,the success rates of attempting vaginal delivery and the situations of changing to cesarean section between two groups were compared.Finally,the situations of complications after surgery of two groups were observed and recorded.Results:Both the bleeding volume of postpartum 24-hour and the oxytocin dosage of the grade Ⅰ group were significantly lower than those of the grade Ⅱ group,and the differences were statistically significant(t=3.221,t=16.056,P<0.05),respectively.There were no significant differences in the operation time,total labor process and hospitalization time,as well as the birth weight,Apgar score,and the incidences of asphyxia,placental abruption and placental adhesions between two groups.The success rate of vaginal delivery of gradeⅠgroup was higher than that in gradeⅡgroup,and the rate of cesarean section of former was lower,and the difference of delivery mode between two groups was significant(x^(2)=24.115,P<0.05).The incidence rate of postoperative complication of former was significantly lower than that of gradeⅡgroup,and the difference was statistically significant(x^(2)=4.099,P<0.05).Conclusion:The muscularis thicknesses of the lower segments of different scar uteruses have different influences on the delivery modes and outcomes of perinatal children.The success rate of attempting vaginal delivery of pregnant women whose muscularis thicknesses of the lower segments of scar uteruses are≤3 mm are lower after re-pregnancy,which might increase the incidence rates of placenta and postoperative complication.This kind of pregnant woman exists high risk in changing vaginal delivery to cesarean section,therefore,the preparations should be prepared in advance so as to reduce the risk of uterine rupture.