Caesarean section is dramatically increased throughout the world in recent years. Rupture of the uterus is a devastating complication in trial of labour following previous Caesarean section. Evidence suggests that the...Caesarean section is dramatically increased throughout the world in recent years. Rupture of the uterus is a devastating complication in trial of labour following previous Caesarean section. Evidence suggests that the size of the uterine scar and the residual myometrial thickness (RMT) are associated directly with the risk of uterine rupture and risk of dehiscence in subsequent deliveries. Impact of the prelabour and labour Cesarean section on the RMT has not been studied in detail. Objectives: To compare RMT, Caesarean scar defects and to evaluate the elasticity of the Caesarean scar between women who underwent prelabour and labour Caesarean sections. Methods: This was a Cross sectional analytical study. Women who underwent Caesarean section in their first pregnancy were recruited. Sample was stratified to prelabour and labour Caesarean section groups. Transvaginal ultrasound scan was performed six months following the Caesarean section. Dimensions of the uterus, uterine scar defect, RMT and elastosonography of the uterine scar were assessed. Results: A total of 240 postpartum women were analyzed. Uterine niche was detectable in 194 subjects. Prelabour CS group had demonstrated 91.7% (n = 110) scar defects (uterine niche) out of 120 cases and the rate among labour CS group was 70% (n = 84). There was a significant difference in the presence of uterine niche among 2 groups as Prelabour group was found to have more scar defects (p mm (SD 1.2) and 4.99 mm (SD 1.3) respectively and there was no significant difference (t = 0.38, p = 0.71). There was no significant difference between the dimensions of the uterine CS defects of the studied groups. Prelabour CS group had significantly higher Target strain [0.28 vs. 0.24 (t = 2.12, p = 0.04)] and significantly less strain ratio [1.45 vs. 1.55 (t -2.42, p = 0.04)] than labour CS group indicating a better scar in prelabour group. Conclusion: There was no significant difference in RMT and uterine scar defects between prelabour and labour Caesarean section groups. But prelabour Caesarean section scars were less stiff than labour Caesarean section scars. Further studies are warranted to elaborate on the association.展开更多
目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)...目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)和双层缝合组(116例);另根据术后是否形成CSD将产妇分为CSD组(23例)和非CSD组(217例)。对比3层缝合组与双层缝合组产妇的临床特点,采用多因素Logistic回归分析CSD形成的独立影响因素并构建人工神经网络模型;采用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线进行模型验证。结果:①3层缝合组产妇的子宫肌层瘢痕厚度显著高于双层缝合组(7.06±2.09 mm vs.5.68±1.97 mm);而CSD形成情况(4.03%vs.15.52%)和憩室大小(0.36±0.09 ml vs.0.47±0.12 ml)则显著低于双层缝合组,差异均有统计学意义(P<0.05);②多因素分析示,子宫后屈、剖宫产次数≥2次、胎膜早破、围产期感染、剖宫产时机(择期)是影响CSD形成的独立危险因素(OR>1,P<0.05),而子宫肌层3层缝合是保护性因素(OR<1,P<0.05);③人工神经网络预测模型显示剖宫产次数、胎膜早破以及是否进行3层缝合所占权重均较高,经ROC曲线、校准曲线和临床决策曲线验证表明该模型预测能力良好。结论:CSD的形成与子宫后屈、剖宫产次数、胎膜早破、围产期感染、剖宫产时机等指标有关,临床应重点关注,此外,子宫肌层3层缝合可降低CSD的形成概率,在临床上值得推广应用。展开更多
目的:探讨无创皮肤吻合器联合心形缝合皮下脂肪对腹部瘢痕的影响。方法:回顾性分析2021年1月—2022年9月于新余市妇幼保健院行剖宫产手术的120例患者的病历资料,将接受无创皮肤吻合器联合心形缝合的60例患者纳入A组,将接受无创皮肤吻合...目的:探讨无创皮肤吻合器联合心形缝合皮下脂肪对腹部瘢痕的影响。方法:回顾性分析2021年1月—2022年9月于新余市妇幼保健院行剖宫产手术的120例患者的病历资料,将接受无创皮肤吻合器联合心形缝合的60例患者纳入A组,将接受无创皮肤吻合器联合传统美容缝合的60例患者纳入B组,两组出院后均随访6个月。比较两组切口缝合时间、切口愈合时间及住院时间,术后24 h、72 h、7 d切口疼痛[视觉模拟评分法(VAS)],术后1个月切口愈合情况、切口并发症发生率,术后6个月切口瘢痕情况[温哥华瘢痕评定量表(VSS)]、缝合效果满意度。结果:两组切口缝合时间差异无统计学意义(P>0.05),A组切口愈合时间与住院时间均短于B组,差异均有统计学意义(P<0.05);两组术后24 h、72 h VAS评分差异均无统计学意义(P>0.05),A组术后7 d VAS评分低于B组,差异有统计学意义(P<0.05);术后1个月,A组伤口愈合等级优于B组,A组切口并发症总发生率低于B组,差异均有统计学意义(P<0.05);术后6个月,A组VSS评分低于B组,A组缝合效果满意度高于B组,差异均有统计学意义(P<0.05)。结论:无创皮肤吻合器联合心形缝合皮下脂肪在剖宫产患者中应用价值高,能有效促进术后患者腹部切口愈合,减少术后疼痛,降低切口并发症发生及瘢痕增生风险,并获得更高的患者满意度。展开更多
文摘Caesarean section is dramatically increased throughout the world in recent years. Rupture of the uterus is a devastating complication in trial of labour following previous Caesarean section. Evidence suggests that the size of the uterine scar and the residual myometrial thickness (RMT) are associated directly with the risk of uterine rupture and risk of dehiscence in subsequent deliveries. Impact of the prelabour and labour Cesarean section on the RMT has not been studied in detail. Objectives: To compare RMT, Caesarean scar defects and to evaluate the elasticity of the Caesarean scar between women who underwent prelabour and labour Caesarean sections. Methods: This was a Cross sectional analytical study. Women who underwent Caesarean section in their first pregnancy were recruited. Sample was stratified to prelabour and labour Caesarean section groups. Transvaginal ultrasound scan was performed six months following the Caesarean section. Dimensions of the uterus, uterine scar defect, RMT and elastosonography of the uterine scar were assessed. Results: A total of 240 postpartum women were analyzed. Uterine niche was detectable in 194 subjects. Prelabour CS group had demonstrated 91.7% (n = 110) scar defects (uterine niche) out of 120 cases and the rate among labour CS group was 70% (n = 84). There was a significant difference in the presence of uterine niche among 2 groups as Prelabour group was found to have more scar defects (p mm (SD 1.2) and 4.99 mm (SD 1.3) respectively and there was no significant difference (t = 0.38, p = 0.71). There was no significant difference between the dimensions of the uterine CS defects of the studied groups. Prelabour CS group had significantly higher Target strain [0.28 vs. 0.24 (t = 2.12, p = 0.04)] and significantly less strain ratio [1.45 vs. 1.55 (t -2.42, p = 0.04)] than labour CS group indicating a better scar in prelabour group. Conclusion: There was no significant difference in RMT and uterine scar defects between prelabour and labour Caesarean section groups. But prelabour Caesarean section scars were less stiff than labour Caesarean section scars. Further studies are warranted to elaborate on the association.
文摘目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)和双层缝合组(116例);另根据术后是否形成CSD将产妇分为CSD组(23例)和非CSD组(217例)。对比3层缝合组与双层缝合组产妇的临床特点,采用多因素Logistic回归分析CSD形成的独立影响因素并构建人工神经网络模型;采用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线进行模型验证。结果:①3层缝合组产妇的子宫肌层瘢痕厚度显著高于双层缝合组(7.06±2.09 mm vs.5.68±1.97 mm);而CSD形成情况(4.03%vs.15.52%)和憩室大小(0.36±0.09 ml vs.0.47±0.12 ml)则显著低于双层缝合组,差异均有统计学意义(P<0.05);②多因素分析示,子宫后屈、剖宫产次数≥2次、胎膜早破、围产期感染、剖宫产时机(择期)是影响CSD形成的独立危险因素(OR>1,P<0.05),而子宫肌层3层缝合是保护性因素(OR<1,P<0.05);③人工神经网络预测模型显示剖宫产次数、胎膜早破以及是否进行3层缝合所占权重均较高,经ROC曲线、校准曲线和临床决策曲线验证表明该模型预测能力良好。结论:CSD的形成与子宫后屈、剖宫产次数、胎膜早破、围产期感染、剖宫产时机等指标有关,临床应重点关注,此外,子宫肌层3层缝合可降低CSD的形成概率,在临床上值得推广应用。
文摘目的:探讨无创皮肤吻合器联合心形缝合皮下脂肪对腹部瘢痕的影响。方法:回顾性分析2021年1月—2022年9月于新余市妇幼保健院行剖宫产手术的120例患者的病历资料,将接受无创皮肤吻合器联合心形缝合的60例患者纳入A组,将接受无创皮肤吻合器联合传统美容缝合的60例患者纳入B组,两组出院后均随访6个月。比较两组切口缝合时间、切口愈合时间及住院时间,术后24 h、72 h、7 d切口疼痛[视觉模拟评分法(VAS)],术后1个月切口愈合情况、切口并发症发生率,术后6个月切口瘢痕情况[温哥华瘢痕评定量表(VSS)]、缝合效果满意度。结果:两组切口缝合时间差异无统计学意义(P>0.05),A组切口愈合时间与住院时间均短于B组,差异均有统计学意义(P<0.05);两组术后24 h、72 h VAS评分差异均无统计学意义(P>0.05),A组术后7 d VAS评分低于B组,差异有统计学意义(P<0.05);术后1个月,A组伤口愈合等级优于B组,A组切口并发症总发生率低于B组,差异均有统计学意义(P<0.05);术后6个月,A组VSS评分低于B组,A组缝合效果满意度高于B组,差异均有统计学意义(P<0.05)。结论:无创皮肤吻合器联合心形缝合皮下脂肪在剖宫产患者中应用价值高,能有效促进术后患者腹部切口愈合,减少术后疼痛,降低切口并发症发生及瘢痕增生风险,并获得更高的患者满意度。
