中孕期瘢痕子宫下段的超声表现及临床意义  

Ultrasound imaging of the lower segment of a scar uterine in mid-trimester of pregnancy and its clinical significance

作　　者：张忠新[1] 杨玉华[2] 郑艳莉[3] 吴爱民[3] 徐海燕[1] 

机构地区：[1]江苏省南通市第一人民医院超声科,南通226001 [2]山西省太原市解放军264医院特诊科 [3]江苏省南通市第一人民医院妇产科

出　　处：《南通大学学报（医学版）》2013年第3期194-196,共3页Journal of Nantong University(Medical sciences)

基　　金：南通市社会事业科技创新与示范计划项目(HS2011033)

摘　　要：目的:观察瘢痕子宫再次妊娠时中孕期的子宫下段超声表现,并探讨其临床意义。方法:观察62例瘢痕子宫及62例对照组孕18～22周间的子宫下段超声表现及胎盘与子宫下段的关系;计算瘢痕缺损率R=D/(T+D),将瘢痕缺损率>60%的瘢痕定为大缺损,缺损率<10%为完整瘢痕,缺损率10%～60%的为小缺损瘢痕;分析完整瘢痕、小缺损瘢痕、大缺损瘢痕与再次剖宫产时子宫下段情况的关系。结果:瘢痕子宫妊娠62例中孕期超声检查示大瘢痕缺陷26例(41.93%),小瘢痕缺陷24例(38.71%),完整瘢痕12例(19.35%);再次剖宫产时发现为不全破裂3例,中孕期超声均显示为大瘢痕缺陷;子宫下段菲薄30例中,中孕期超声表现为大瘢痕缺陷21例(70.0%);62例中孕期胎盘前置状态4例,其中1例发展为前置胎盘并胎盘植入,对照组中孕期胎盘前置状态3例,无1例发展为前置胎盘。结论:瘢痕子宫中孕期超声检查可筛查大缺损瘢痕和胎盘前置状态,以加强孕期管理,确保母婴安全。Objective： Observing the ultrasound imaging of the lower uterine segment during the mid-trimester of a scar uterus pregnancy to discuss its clinical significance.Methods： Ultrasound scan were conducted on 62 cases of scar uterine and 62 cases of normal uterine in a control group between their 18th and 22nd week of pregnancy.The lower uterine segment and the relationships between the placenta and the lower uterine segment were observed,scar defect rate analyzed by R=D/（T＋D）.The scar with its R greater than 60% was defined as major defect,less than 10% as no defect,and between 10%～60% as minor defect.The three defects and their relationships with the lower uterine segment in the second caesarean section were later analyzed.Results： The ultrasound scan on the 62 cases of scar uterine showed that 41.93%（26/62 cases） were major defects,38.71%（24/62 cases） were minor defects and 19.35%（12/62 cases） were no defects.The 3 cases which were found with incomplete rupture in caesarean section all showed major defects on ultrasound scan during the mid-trimester of pregnancy.In the 30 cases of feeble lower uterine segment,21（70.0%） showed major defects.One of the 4 cases of placenta previa found during the mid-trimester of pregnancy developed into placenta previa with placenta accreta while none of the 3 cases with tendency of placenta previa during the mid-trimester of pregnancy developed into one.Conclusions： Ultrasound scan during the mid-trimester of pregnancy can screen the occurrence of major defect scar and tendency of placenta previa so as to enhance pregnancy care,making sure the maternal and infants’ safety.

关 键 词：瘢痕子宫 瘢痕缺损率 凶险型胎盘前置状态 

分 类 号：R714[医药卫生—妇产科学]