瘢痕子宫再妊娠孕妇子宫肌层厚度与不良妊娠结局关系

Correlation between the muscular layer thickness of pregnant women with scarred uterus and their adverse pregnancy outcomes

目的:探究肌层厚度与瘢痕子宫再妊娠不良结局关系。方法:收集本院2020年5月-2022年6月诊治的瘢痕子宫再妊娠孕妇84例临床资料,孕中期检测肌层厚度并统计孕妇妊娠结局,比较不同肌层厚度孕妇妊娠结局以及新生儿结局,分析肌层厚度与妊娠不良结局的相关性。结果:子宫肌层厚度≥4mm组剖宫产术中出血量、不完全子宫破裂率、产后出血率、子宫收缩乏力率、新生儿低体重率以及新生儿呼吸系统疾病率均低于子宫肌层厚度1~4mm组和<1mm组(P<0.05),三组新生儿体重和新生儿转科率无差异(P>0.05);结局不良组孕妇年龄>30岁、子宫肌层厚度<4mm、产前体质指数(BMI)≥30kg/m^(2)以及分娩孕周>38周占比均高于妊娠结局良好组(P<0.05),两组文化程度、距前次剖宫产间隔时间无差异(P>0.05)。logistic回归分析显示,孕妇年龄>30岁、子宫肌层厚度<4mm、产前BMI≥30kg/m^(2)以及分娩孕周>38周均是影响不良妊娠结局的独立危险因素(P<0.05);受试者工作特征曲线显示,子宫肌层厚度预测妊娠不良结局的曲线下面积为0.807(95%CI0.718~0.897)。结论:瘢痕子宫再妊娠孕妇孕中期子宫肌层厚度较薄是导致孕妇不良妊娠结局的独立危险因素,且对不良妊娠结局的发生风险有预测价值。

Objective:To study the correlation between the muscular layer thickness of pregnant women with scarred u-terus and their adverse pregnancy outcomes.Methods:The clinical data of 84 pregnant women with scarred uterus who were diagnosed and treated in hospital from May 2020 to June 2022 were collected.The muscle layer thickness of the women during the second trimester of pregnancy were measured,and the pregnancy outcomes of the women were cal-culated.The maternal and the neonatal outcomes were compared among the women with different muscle layer thick-ness,and the correlation between the muscle layer thickness of the women and their adverse pregnancy outcomes was analyzed.Results:The intraoperative blood loss,the incomplete uterine rupture rate,the postpartum hemorrhage rate,the uterine atony rate,the neonatal low body weight rate and the neonatal respiratory disease rate of the women with muscular thickness 4mm were significantly lower than those of the women with muscular thickness of 1-4mm(P<0.05).There were no statistically significant differences in the neonatal body weight and the rate of the neonatal transfer to other department among the three groups(P>0.05).The rates of>30 years old,the myometrium thick-ness<4mm,the prenatal BMI≥30kg/m^(2) and the delivery gestational week>38 weeks of the women with adverse pregnancy outcomes were significantly higher than those of the women with normal pregnancy outcomes(P<0.05).There were no statistically significant differences in the education level and the interval from the previous cesarean sec-tion of the women between the two groups(P>0.05).Logistic regression analysis showed that the maternal age>30 years old,the myometrium thickness<4mm,the prenatal BMI≥30kg/m^(2) and the delivery gestational week>38 weeks of the women were the independent risk factors of their adverse pregnancy outcomes(P<0.05).Receiver oper-ating characteristic(ROC)curve showed that the area under the curve of the myometrium thickness of the women for predicting their adverse pregnancy outcomes was 0.807(95%CI:0.718-0.897).Conclusion:The thin myometrium thickness of the pregnant women with scarred uterus during the second trimester of pregnancy is an independent risk factor of their adverse pregnancy outcomes,and which has some predictive value for the risk of the adverse pregnancy outcomes of the women.