增加剖宫产瘢痕缺损深度的危险因素研究

Study on the risk factors of the increase of cesarean scar defect depth

目的:探讨剖宫产瘢痕缺损的发生率及增加剖宫产瘢痕缺损深度的危险因素。方法:2011年7-12月收治行剖宫产妇女995例次,行经阴道B超检查了解子宫位置、切口距宫颈内口距离、缺损处肌层厚度,根据缺损处子宫肌层厚度,将患者分为大缺损组和小缺损组。结果:195例患者存在瘢痕缺损,发生率19.6%(195/995);其中88例患者存在大缺损,发生率8.8%(88/995),107例患者存在小缺损,发生率10.8%(107/995)。子宫后位、剖宫产次数≥2次、术前使用缩宫素、试产时间≥5 h、宫口扩张≥5 cm、胎先露已衔接、切口距宫颈内口<5 mm的孕产妇大缺损的发生率明显升高。结论:子宫后位、切口距宫颈内口近、剖宫产次数多、使用缩宫素、试产时间长、宫口扩张程度大、胎先露衔接是增加剖宫产瘢痕缺损深度的危险因素,要加强对阴道分娩的准确评估。

Objective:To investigate the incidence of cesarean section scar defect and the risk factors of the increase of cesarean scar defect depth.Methods:995 women with cesarean section were selected from July to December 2011.They were given vaginal B ultrasound examination to understand uterine position,distance from cervical incision inside the mouth,the defect in the muscle layer thickness.According to the defect of uterine muscular layer thickness,the patients were divided into the large defect group and the small defect group.Results:195 patients had scar defect,and occurence rate was 19.6%(195/995);88 patients had the presence of large defect,and occurence rate was 8.8%(88/995);107 patients had small defect,and occurence rate was 10.8%(107/995).Large defect incidence of pregnant women with retroposition of uterus,cesarean section with more than 2 times,the preoperative use of oxytocin,pilot run longer than 5 hours,dilatation of cervix greater than 5 cm,cohesion of fetal presentation,incision from the endocervix less than 5 mm was increased obviously.Conclusion:Retroposition of uterus,cervix incision inside the mouth near distance,the more number of cesarean section,use of oxytocin,long trial production time,the large degree of cervical dilation,cohesion of fetal presentation were risk factors for the increase of cesarean scar defect depth.We must strengthen the accurate assessment of vaginal delivery.