Vaginal Cesarean Section, an Alternative to High-Risk Trigger on Scarred Uterus

The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.

Predictive Factors of Complications of Vaginal Delivery on Scarred Uterus at the YaoundéGynaeco-Obstetric and Paediatric Hospital

Objective: This study was aimed at identifying predictive factors of complications during vaginal delivery on scarred uterus. Methodology: During 9 months, from October 1st, 2015 to June 30th, 2016, a case control study was carried out at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. Eighty nine women each with a single scarred uterus who presented with complications during delivery (cases) were compared to eighty nine others who had a successfully trial of scar (control) during the study period. Data were analyzed using the CSPro version 6.0 and SPSS version 20.0 softwares with statistical significance set at P Results: We recruited 2 groups of 89 women, aged 17 to 40 years, with an average age of 29.05 years. The majority of women with complications were married (50.6%) and unemployed (42.8%). Following univariate analysis, predictive factors of complications were: prematurity (OR = 7.4), post-term (OR = 13.7), no history of vaginal delivery on scarred uterus (OR = 4.3), inter-pregnancy spacing period greater than 60 months (five years) (OR = 2.9), History of caesarian delivery indicated for cephalo-pelvic disproportion (OR = 6.6), less than four ante-natal consultations (OR = 3.6), antenatal consultations done in a Health Centre (OR = 2.7), ante-natal follow up conducted by a nurse (OR = 2.4;IC = [1.2 - 4.7]), referral from a different health unit (OR = 4.4, IC = 2.0 - 9.4), a Bishop score less than 7 on admission (OR = 12.4, IC = 5.6 - 27.4), a meconium stained amniotic fluid (OR = 9.9;CI = [3.6 - 26.8]). After logistic regression, the retained factors associated with complications were post-term (aOR = 34.5), absence of vaginal birth after caesarian delivery, (aOR = 11.7), previous caesarean section indicated for cephalo-pelvic disproportion (aOR = 6.1), a bishop score less than 7 (aOR = 12.0), meconium stained amniotic fluid (aOR = 13.6). Conclusion: Predictive factors of complications can help anticipate negative obstetric outcomes.

Placenta Percreta Causing Rupture of Uterus in Second Trimester of Pregnancy in Non Scarred Uterus with an Unusual Presentation: A Case Report and Review of Literature

Placenta percreta causing second trimester, spontaneous uterine rupture in non high risk women is less frequent and fewer cases have been reported in the literature. We report a case of uterine rupture in second trimester of pregnancy due to placenta percreta with non specific symptoms in otherwise uncomplicated pregnancy without any high risk factors. This case report describes the case of young woman presenting second gravid with 21 weeks pregnancy with complaints of whole abdomen pain and dysuria. Ultrasonography shows single intrauterine dead fetus;placenta was fundoposterior in upper segment, a hypoechoic area seen below the placenta suggestive of abruption placentae or placenta accreta. Suddenly patient deteriorated in two hours of hospital stay, frank hemoperitoneum detected, emergency laparotomy done, per operatively whole fundal area of uterus became papery thin and cystic on touch, a small rent seen on fundal surface of uterus. The placenta was densely adhered to the fundoposterior aspect of the uterus. Patient had emergency subtotal hysterectomy. This case highlights that placenta percreta is a rare but serious complication of pregnancy which may present in early pregnancy without any associated high risk factors for placenta percreta with unusual symptoms.

Delivery on Scarred Uterus at Souro Sanou Teaching Hospital, Burkina Faso (about 531 Cases)

Introduction: Therapeutic conduct for delivery via a scarred uterus is controversial in modern obstetrics. Some authors recommend a ceasarean section. The purpose of this study was to analyse the conduct and prognosis of delivery via scarred uterus at Souro Sanou Teaching Hospital in Bobo-Dioulasso. Methods: We conducted a descriptive cross-sectional study from January 1 to December 31, 2017. Data were collected from medical, birth, and operating room records. Result: In total, 531 scared uterus deliveries and 5293 deliveries have been recorded in our study;the frequency of deliveries via a scarred uterus was 9.96%. The average age of the patients was 28.02 years old, with extremes of 17 and 44 years. The average parity was 2.34, with extremes of 1 and 8. Patients with a spacing interval between births of at least 24 months accounted for 86.6% of observed patients. Patients with a single scar uterus made up 70.6% of the population. There were 349 (65.73%) patients who had an emergency caesarean section during a previous delivery. The trial of vaginal delivery via a scarred uterus was conducted on 182 patients with a success rate of 89.56%. There was no maternal death. However, we noted 23 foetal deaths (4.33%). Conclusion: More than 50% of parturient women with a single caesarean uterine scar who underwent the uterine test gave birth vaginally in our department. However, like most previous studies on the subject, we recommend vaginal delivery in the presence of a prior caesarean-scarred uterus whenever possible.

Emergency C-Section on Multi-Scar Uterus: Maternal and Fetal Prognosis at the Nianankoro Fomba Hospital in Segou, Mali

Background: Multi-scar uterus is a uterus with two or more scars due to surgery or trauma. Objective: The aim was to compare the maternal and fetal prognosis of emergency C-sections of bi-scar uteruses to those of uteruses with at least 3 scars at the Nianankoro Fomba Hospital in Segou. Materials and Methods: It was a descriptive and analytical cross-sectional study with prospective data collection over a 24-month period from March 20, 2018, to March 20, 2020. Results: In 2 years, we collected 103 emergency C-sections for multi-scar uterus out of 1198 C-sections with a frequency of 8.6%. The age group of 20 to 35 years was the most represented with 86.4%. The bi-scar uteruses were the most frequent with 77.7%. In 71.8% of cases, the C-section was performed during the latent phase of labor. The C-section was performed under loco-regional anesthesia in 89.3% of cases. Difficulties in hemostasis and bladder injury were the most frequent intraoperative accidents. Surgical site infection was the main postoperative complication. No maternal deaths were recorded. The perinatal prognosis was marked by 4.3% fresh stillbirths in bi-scar uterus against 3.7% in three or more scar uteruses and including 2 fresh stillbirths and 1 macerated. We did not record any early neonatal deaths after C-section. Conclusion: The frequency of emergency C-sections in patients with a multi-scar uterus remains very high in our hospital. A better awareness of the patients, their spouses and all the actors involved in the management of pregnancies and childbirth, can contribute to curb this trend.

瘢痕子宫再次妊娠孕妇孕晚期抑郁发生情况及影响因素

目的:调查瘢痕子宫(SU)再次妊娠孕妇孕晚期抑郁发生情况并分析影响因素。方法:选择2021年1月-2023年12月在本院产前检测的278例SU再次妊娠孕妇,均于孕晚期采用健康问卷(PHQ-9)评定,根据评估结果分成抑郁组和无抑郁组。收集两组17项资料并开展比较,通过多因素分析筛查SU再次妊娠孕妇孕晚期抑郁发生的影响因素。结果:22.3%(62/278)的SU再次妊娠孕妇孕晚期发生抑郁;抑郁组和无抑郁组学历、不良妊娠经历、睡眠状况、妊娠并发症、性格内向、家庭关怀度、近期出现负性生活事件等均有差异(P<0.05);SU再次妊娠孕妇孕晚期抑郁发生的危险因素主要包括有不良妊娠经历(OR=2.816,95%CI 1.570~5.050)、睡眠状况差(OR=2.514,95%CI 1.377~4.589)、性格内向(OR=2.408,95%CI 1.289~4.500)、家庭关怀度差(OR=3.022,95%CI 1.708~5.316)、近期出现负性生活事件(OR=2.862,95%CI 1.577~5.193)。结论:不良妊娠经历、睡眠状况差、性格内向、家庭关怀度差、近期出现负性生活事件与SU再次妊娠孕妇孕晚期抑郁发生有关。提示临床应针对上述情况施以孕妇针对性教育、心理支持及健康行为干预,以预防抑郁发生。

剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性分析

目的 研究剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性。方法 选择剖宫产术后再次妊娠行阴道试产的66例产妇作为瘢痕组,另选择同期非瘢痕子宫妊娠行阴道试产的66例产妇作为非瘢痕组。比较两组阴道试产结果,阴道试产成功产妇产程,产后出血量、住院时间及产后胎盘残留发生情况,不良妊娠结局发生情况,新生儿Apgar评分。结果 瘢痕组与非瘢痕组的阴道试产成功率(78.79%VS 84.85%)、转剖宫产率(21.21%VS 15.15%)比较,差异无统计学意义(P>0.05)。瘢痕组阴道试产成功产妇第一、二、三产程及总产程时间与非瘢痕组比较,差异无统计学意义(P>0.05)。瘢痕组产后出血量(210.28±56.36)ml、住院时间(3.69±1.62)d和产后胎盘残留发生率12.12%与非瘢痕组的(205.17±49.69)ml、(3.71±1.59)d、7.58%(5/66)比较,差异无统计学意义(P>0.05)。瘢痕组不良妊娠结局发生率(13.64%)与非瘢痕组(10.61%)比较,差异无统计学意义(P>0.05)。瘢痕组出生后1、5、10 min的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。两组新生儿预后良好,无转入新生儿科记录。结论 剖宫产术后瘢痕子宫再次妊娠产妇的阴道试产成功率与非瘢痕子宫妊娠产妇基本一致,且未增加产程时间及产后出血量,不良妊娠结局发生率无明显升高,临床应用安全性可靠,证实该类产妇经阴道分娩的可行性较强,对提升阴道分娩率及降低剖宫产率具有重要应用价值。

卡前列素氨丁三醇注射液不同时机给药对瘢痕子宫患者再次剖宫产术后出血的预防效果

目的探究卡前列素氨丁三醇注射液不同时机给药对瘢痕子宫患者再次剖宫产术后出血的预防效果。方法选取2019年1月至2022年5月丰城市人民医院收治的80例瘢痕子宫再次剖宫产患者作为研究对象,采用随机数字表法分为A组与B组,每组40例。A组在宫缩乏力时给予卡前列素氨丁三醇注射液,B组在胎儿娩出后即刻给予卡前列素氨丁三醇注射液。比较两组产后出血量、血流动力学指标[心率(HR)、平均动脉压(MAP)]、凝血功能[D-二聚体(D-D)、纤溶酶-抗纤溶酶复合物(PAP)、凝血酶-抗凝血酶复合物(TAT)、纤维蛋白原(Fg)]、康复时间及不良反应发生情况。结果术中及术后2、24h,B组出血量均少于A组,差异有统计学意义(P<0.05)。术后24h时,B组HR水平低于A组,MAP水平高于A组,差异有统计学意义(P<0.05)。术后24h时,B组D-D、PAP、Fg水平均低于A组,TAT水平高于A组,差异有统计学意义(P<0.05)。B组肛门排气时间、排便时间、下床时间、住院时间均短于A组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论在瘢痕子宫患者再次剖宫产术胎儿娩出后即刻给予卡前列素氨丁三醇注射液,可减少产后出血量,缩短术后康复时间,且不增加不良反应发生,值得临床推广应用。

孕晚期血清血小板反应蛋白-1、D-二聚体及金属蛋白酶组织抑制物-1水平对瘢痕子宫再次妊娠患者产后出血的预测价值

目的探讨孕晚期血清血小板反应蛋白-1(THBS-1)、D-二聚体(D-D)及金属蛋白酶组织抑制物-1(TIMP-1)水平对瘢痕子宫再次妊娠患者产后出血(PPH)的预测价值。方法选择2020年6月至2022年8月新乡医学院第一附属医院收治的108例瘢痕子宫再次妊娠孕妇为研究对象,根据孕妇分娩后是否发生PPH分为PPH组(n=21)和非PPH组(n=87)。采集2组孕妇入院当天肘静脉血5 mL,应用酶联免疫吸附法检测2组孕妇血清THBS-1、D-D、TIMP-1水平。比较2组孕妇的基本临床资料及血清THBS-1、D-D、TIMP-1水平。采用多因素logistic回归分析瘢痕子宫再次妊娠孕妇发生PPH的影响因素,受试者操作特征(ROC)曲线分析血清THBS-1、D-D、TIMP-1水平对瘢痕子宫再次妊娠孕妇发生PPH的预测价值。结果PPH组人工流产次数≥2次、胎盘早剥、子宫切口撕裂、宫缩乏力、瘢痕厚度<0.3 cm占比及孕晚期血清THBS-1、D-D水平显著高于非PPH组,血清TIMP-1水平显著低于非PPH组(P<0.05)。宫缩乏力、D-D和THBS-1水平升高是瘢痕子宫再次妊娠孕妇PPH的独立危险因素(P<0.05),TIMP-1水平降低是瘢痕子宫再次妊娠孕妇PPH的保护因素(P<0.05)。血清THBS-1、D-D、TIMP-1联合预测瘢痕子宫再次妊娠孕妇PPH的曲线下面积大于三者单独预测(P<0.05)。结论孕晚期血清THBS-1、D-D、TIMP-1水平均可作为预测瘢痕子宫再次妊娠孕妇发生PPH的参考指标,且三者联合对瘢痕子宫再次妊娠孕妇发生PPH的预测效能更高。

多元共享决策模式对瘢痕子宫再次妊娠分娩方式的影响

目的探究决策辅助手册联合在线分娩决策支持的多元共享决策模式对瘢痕子宫再次妊娠女性分娩方式的影响。方法选取2019年9月至2022年10月在某三甲医院产检的94例瘢痕子宫再次妊娠女性为研究对象,采用随机数字表法分为观察组与对照组。对照组接受常规孕期宣教,观察组在常规孕期宣教的基础上接受多元共享决策干预。分别对两组分娩决策冲突程度、分娩方式偏好、分娩后决策后悔程度和最终分娩方式进行比较。结果观察组在接受多元共享决策干预后,决策冲突量表得分降低(P<0.001),在分娩方式偏好调查中表示“不确定”的人数减少,选择经阴道生产的人数增加;最终观察组孕妇行剖宫产者30人(68.2%),阴道分娩者14人(31.8%);观察组孕妇对本次分娩决策后悔程度低于对照组(P<0.001)。结论对瘢痕子宫再次妊娠女性开展多元共享决策可降低其决策冲突程度、增强阴道试产意愿并帮助其做出理性科学的分娩决策。

43例子宫破裂的临床分析

目的:探讨子宫破裂产妇的临床特点和妊娠结局。方法:回顾性分析2016年12月-2022年12月在南京医科大学附属妇产医院分娩的43例子宫破裂产妇的临床资料,按照是否有子宫手术史,分为瘢痕子宫组和非瘢痕子宫组,比较其临床特点和妊娠结局,并对20例经阴道试产发生子宫破裂产妇的产时情况进行分析。结果:43例子宫破裂产妇中瘢痕子宫33例,非瘢痕子宫10例;与瘢痕子宫组相比,非瘢痕子宫组术中出血量≥1000 mL的比例(P<0.001)、累积出血量≥1000 mL的比例(P=0.003)更高,输血率更高(P=0.012)。43例子宫破裂中预期剖宫产23例,余20例阴道试产者中产后发现子宫破裂组(13例)与产时发现子宫破裂组(7例)相比,产后发现子宫破裂组中完全性子宫破裂占比明显增加(P=0.044),输血率显著增加(P<0.001),两组相比差异有统计学意义。此外,与产后发现子宫破裂组相比,产时发现子宫破裂组中羊水异常比例和胎心改变比例增高,虽差异无统计学意义(P>0.05),但仍需引起临床高度重视。结论:非瘢痕子宫发生子宫破裂时出血量更多,阴道试产者于产后发现子宫破裂的并发症更严重,分娩前后应密切注意羊水、胎心、生命体征等情况,及时发现子宫破裂,降低母儿不良妊娠结局的发生率。

The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

Background：Spinal anesthesia is considered as a reasonable anesthetic option in lower abdominal and lower limb surgery.This study was to determine the dose-response of intrathecal ropivacaine in patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia.Methods：Seventy-five patients with scarred uterus undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this randomized,double-blinded,dose-ranging study.Patients received 6,8,10,12,or 14 mg intrathecal hyperbaric ropivacaine with 5 μg sufentanil.Successful spinal anesthesia was defined as a T4 sensory level achieved with no need for epidural supplementation.The 50％ effective dose （ED50） and 95％ effective dose （ED95） were calculated with a logistic regression model.Results：ED50 and ED95 ofintrathecal hyperbaric ropivacaine for patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia （CSEA） were 8.28 mg （95％ confidence interval [CI]：2.28-9.83 mg） and 12.24 mg （95％ CI：10.53-21.88 mg）,respectively.Conclusion：When a CSEA technique is to use in patients with scarred uterus for an elective cesarean delivery,the ED50 and ED95 of intrathecal hyperbaric ropivacaine along with 5 μg sufentanil were 8.28 mg and 12.24 mg,respectively.In addition,this local anesthetic is unsuitable for emergent cesarean delivery,but it has advantages for ambulatory patients.

子宫下段前壁叠瓦式缝合术治疗瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的临床效果

目的观察子宫下段前壁叠瓦式缝合术治疗瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的临床效果。方法回顾性选取2020年1月至2023年1月诊断为瘢痕子宫合并前置胎盘伴胎盘植入的100例产妇,按照手术治疗方法将其分为试验组(50例,子宫下段前壁叠瓦式缝合术)和对照组(50例,传统局部“8”字缝合术)。比较两组的止血效果、临床指标、血红蛋白水平及术后并发症发生情况。结果试验组的止血总有效率高于对照组,差异具有统计学意义(P<0.05)。试验组的手术时间短于对照组,红细胞输注量、血浆输注量、术后24 h总出血量、术中及术后缩宫素使用剂量、术中及术后欣母沛使用剂量少于对照组(P<0.05)。试验组的术后并发症总发生率明显低于对照组(P<0.05)。结论相较于传统局部“8”字缝合术,子宫下段前壁叠瓦式缝合术可为瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的治疗提供一些新思路,是治疗此类患者的一种安全、有效的方法。

瘢痕子宫妊娠无症状型子宫破裂1例报告

子宫破裂是一种严重的产科并发症,指在分娩期或妊娠期间,子宫体部或子宫下段发生破裂,导致母儿灾难性后果。本研究回顾性分析1例瘢痕子宫妊娠无症状型子宫破裂患者的临床资料,探讨瘢痕子宫妊娠的处理策略。

卡孕栓联合缩宫素预防瘢痕子宫剖宫产产后出血的效果及对凝血指标的影响

目的探讨卡孕栓联合缩宫素在预防瘢痕子宫剖宫产产后出血中的应用效果及其对凝血指标的影响。方法将94例行剖宫产手术的瘢痕子宫产妇随机分为观察组与对照组,每组47例。对照组在剖宫产产后采用缩宫素进行止血,观察组采用卡孕栓联合缩宫素进行止血。比较2组临床效果、产后出血量、凝血指标以及不良反应。结果与对照组相比,观察组总有效率显著升高,产后2、24 h出血量显著减少,活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)显著缩短,D-二聚体(D-D)、纤维蛋白原(FIB)水平显著升高,差异均有统计学意义(P<0.05);2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论卡孕栓联合缩宫素预防瘢痕子宫剖宫产产后出血效果显著,利于减少产妇产后出血量,改善产妇凝血功能,且安全性较高。

瘢痕子宫妊娠中期引产方法的研究

目的 观察应用宫颈扩张球囊联合乳酸依沙吖啶注射液对瘢痕子宫妊娠患者中期引产的效果及对患者产后心理的影响。方法 选取2022年1月至2023年12月在我院就诊的瘢痕子宫妊娠中期引产患者128例,随机分为观察组和对照组,每组64例。对照组患者采用传统的米非司酮150 mg口服+乳酸依沙吖啶注射液100 mg羊膜腔内注射引产;观察组患者采用COOK宫颈扩张球囊促宫颈成熟+米非司酮150 mg口服+乳酸依沙吖啶注射液50 mg羊膜腔内注射引产。对比2组患者的引产总时间、产程总时间、产后出血量、引产总有效率、软产道裂伤发生率、先兆子宫破裂发生率及产后心理状况。结果 观察组患者的总有效率高于对照组,引产总时间及产程总时间短于对照组,产后出血量少于对照组,差异均有统计学意义(P<0.05)。2组患者并发症发生率比较,差异无统计学意义(P>0.05)。对照组爱丁堡产后抑郁量表(EPDS)阳性患者比例明显高于观察组(t=10.818,P<0.05),2组患者在EPDS中的10个情绪方面比较,差异有统计学意义(P<0.05)。结论 对于瘢痕子宫妊娠中期患者,使用COOK宫颈扩张球囊促宫颈成熟+米非司酮150 mg口服+50 mg乳酸依沙吖啶注射液羊膜腔内注射引产的效果良好,有利于产妇产后心理健康。

探讨瘢痕子宫再次妊娠经阴道分娩的可行性及安全性

目的探讨瘢痕子宫再次妊娠经阴道分娩的可行性及安全性。方法选取80例瘢痕子宫再次妊娠分娩产妇,根据分娩方式不同分为观察组与对照组,每组40例。观察组选择经阴道试产,对照组选择剖宫产术。记录观察组产妇经阴道试产成功率,比较两组产妇产后出血量、住院时间及并发症发生情况。结果观察组产妇试产成功率为85.00%;观察组产妇产后出血量少于对照组,住院时间短于对照组(P<0.05)。观察组产妇并发症发生率显著低于对照组(P<0.05)。结论在严格遵循阴道分娩和剖宫产适应证的基础上,对瘢痕子宫产妇,经阴道试产具有可行性和安全性。

产程进展角、胎头下降距离及其变化率在剖宫产术后瘢痕子宫经阴道试产结局预测中的价值

目的探讨产程进展角(AOP)、胎头下降距离(HPD)及其变化率在剖宫产术后瘢痕子宫经阴道试产结局预测中的价值。方法选取剖宫产术后瘢痕子宫再次妊娠经阴道试产的170例孕妇为研究对象,依据试产结局将其分为成功组和失败组。分别采用超声测量第一产程活跃期宫口扩张至4 cm时以及1 h时(宫口开至4 cm后1 h)AOP、HPD,并计算1 h时AOP变化率、HPD变化率。采用受试者工作特征(ROC)曲线分析AOP、HPD及其变化率对剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的预测效能,采用Delong检验比较不同曲线下面积(AUC)的差异。结果170例剖宫产术后瘢痕子宫再次妊娠孕妇中,经阴道试产成功分娩为139例(成功组),试产失败转剖宫产为31例(失败组)。成功组在宫口开至4 cm时的AOP大于失败组,HPD短于失败组,差异均有统计学意义(P<0.05);成功组宫口开至4 cm、1 h时的AOP变化率、HPD变化率均大于失败组,差异有统计学意义(P<0.05)。AOP与HPD预测剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的AUC分别为0.846、0.812,AOP与HPD联合预测的AUC与单独预测的AUC比较,差异无统计学意义(P>0.05)。AOP与HPD的变化率预测剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的AUC分别为0.899、0.852;AOP变化率与HPD变化率联合预测的AUC大于单独预测的AUC,且大于AOP与HPD联合预测的AUC,差异均有统计学意义(P<0.05)。结论第一产程活跃期宫口扩张至4 cm时的AOP、HPD及其变化率对剖宫产术后瘢痕子宫再次妊娠经阴道试产结局具有预测价值。

瘢痕子宫再次妊娠时血栓弹力图及RDW-CV、NLR、MLR、SII等指标变化情况

目的 本研究旨在分析瘢痕子宫再次妊娠时血栓弹力图(thromboelasmography,TEG)及红细胞分布宽度变异系数(red blood cell distribution width coefficient of variation,RDW-CV)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、单核细胞/淋巴细胞比值(monocyte lymphocyte ratio,MLR)以及全身免疫炎症指数(systemic immune-inflammation index,SII)等指标的变化情况,探讨凝血相关指标及炎症相关指标对瘢痕子宫再次妊娠风险预测价值。方法 回顾2021年3月1日至2024年3月1日在延安市人民医院产科住院的孕妇临床资料168例。比较瘢痕子宫不同妊娠阶段TEG及RDW-CV、NLR、MLR、SII等炎症指标的变化;比较瘢痕子宫孕妇与健康孕妇TEG及RDW-CV、NLR、MLR、SII等炎症指标的变化情况。结果 瘢痕子宫孕妇中,与中孕组相比,晚孕组孕妇TEG中的R值增加,Angle角、MA值减少(均P<0.05);NLR、MLR增高(P<0.05)。瘢痕子宫孕妇与健康孕妇相比,瘢痕子宫TEG中的R值、K值、Angle角、MA值的差异无统计学意义(均P>0.05);NLR、MLR差异有统计学意义(P<0.05)。结论 瘢痕子宫再次妊娠对TEG及部分炎症指标有影响,随着孕周数增加TEG指标与炎症指标有所变化;TEG及炎症指标联合检测可对瘢痕子宫再次妊娠风险作出预测。

彩色多普勒超声联合二维超声检查在瘢痕子宫合并前置胎盘植入诊断中的效能

目的:分析彩色多普勒超声联合二维超声检查在瘢痕子宫合并前置胎盘植入诊断中的效能。方法:选取2021年1月至2023年1月该院收治的110例瘢痕子宫妊娠患者进行前瞻性研究。所有患者均行彩色多普勒超声和二维超声检查,以病理结果为“金标准”,分析彩色多普勒超声联合二维超声检查在瘢痕子宫合并前置胎盘植入诊断中的效能。结果:金标准结果显示,110例瘢痕子宫妊娠患者中,阳性69例,阴性41例;其中穿透性植入19例,深层植入26例,浅层植入24例。彩色多普勒超声检查结果显示,阳性64例,阴性46例,其中误诊10例,漏诊15例;二维超声检查结果显示,阳性62例,阴性48例,其中误诊14例,漏诊21例;彩色多普勒超声联合二维超声检查结果显示,阳性70例,阴性40例,其中误诊3例,漏诊2例。彩色多普勒超声联合二维超声检查诊断瘢痕子宫合并前置胎盘植入的灵敏度、特异度、准确度均高于二者单项检查,且漏诊率、误诊率均低于二者单项检查,差异有统计学意义(P<0.05);彩色多普勒超声联合二维超声检查诊断穿透性植入、浅层植入的检出率均高于二者单项检查,差异有统计学意义(P<0.05);三种检查的深层植入检出率比较,差异均无统计学意义(P>0.05)。结论:彩色多普勒超声联合二维超声检查诊断瘢痕子宫合并前置胎盘植入的效能高于二者单项检查。