超声检查在瘢痕子宫孕妇选择分娩方式中的意义  

Significance of Ultrasonography in Selection of Delivery Way for Pregnant Women with Scar Uterus

作　　者：高欢 赵霞[2] GAO Huan;ZHAO Xia(Shihezi Univerisity School of Medicine,Xinjiang Shihezi,832002;Department of Obstetrics-Gynecology,the First Affiliated Hospital of Shihezi University School of Medicine,Xinjiang Shihezi,832008)

机构地区：[1]石河子大学医学院,新疆石河子832002 [2]石河子大学医学院第一附属医院妇产科,新疆石河子832008

出　　处：《农垦医学》2021年第4期312-316,共5页Journal of Nongken Medicine

摘　　要：目的:探讨超声检查子宫下段对瘢痕子宫再次妊娠孕妇选择分娩方式的意义。方法:选取我院于2019年1月至2020年8月产科收治的瘢痕子宫再次分娩孕妇139例,收集与分析其病案资料,利用超声检查评估瘢痕子宫下段肌层情况,分析超声检查在选择分娩方式上的临床意义。结果:前次剖宫产手术的主要指征依次为社会因素34例(24.46%),头盆不称31例(22.3%),异常分娩27例(19.42%),其余为胎儿宫内窘迫、胎盘异常、引产失败、妊娠期高血压疾病及其他;剖宫产术后再次妊娠行阴道试产的成功率为31.11%;阴道试产成功组、试产失败组及剖宫产组相比较,产时出血量、产后有无并发症及新生儿体重、Apgar评分(出生1分钟)、Apgar评分(出生5分钟)组间差异均无统计学意义(P>0.05);阴道试产成功与否与孕妇的子宫下段肌层厚度有关系,差异有统计学意义(P<0.05),本研究中阴道试产组孕妇子宫下段肌层厚度较剖宫产组更小;超声检测不同孕周瘢痕子宫前壁下段肌层的厚度有差异(P<0.05),随孕周的增加而子宫下段肌层的厚度逐渐减小;两组不同孕周的子宫前壁下段肌层的连续性的差异无统计学意义(P>0.05)。结论:超声检查子宫下段的连续性在瘢痕子宫再次妊娠的孕妇再次选择分娩方式上可作为参考,但不建议将子宫下段肌层的厚度纳入临床参考依据。Objective:To discuss the clinical significance if ultrasound examination of lower part of uterus of delivery mode selection in pregnant women with scared uterus.Method:139 pregnant women who delivered babies in our hospital with scar uterus from January 2019 to August 2020 were admitted to our study.Data of all the pregnant women and ultrasonic examination of the lower part of scared uterus in late pregnancy were collected and analyzed to assess the clinical significance of ultrasound in choosing the delivery mode.Results:In our study,the indications for the previous cesarean section were 34 cases(24.46%)of social factors,31 cases(22.3%)of cephalopelvic disproportion,27 cases(19.42%)of abnormal delivery,and the rest were fetal distress、abnormal placenta,failed labor induction,hypertension in pregnancy and the others.The success rate of vaginal trial delivery after cesarean section was 31.11%.Comparing the successful vaginal delivery group,the failed trial delivery group and the cesarean section group,the amount of bleeding during delivery,postpartum complications and newborn weight,Apgar score(1 minute of birth),Apgar score(5 minutes of birth)between groups.The differences were not statistically significant(P>0.05).The success of vaginal delivery is related to the thickness of the lower uterine muscle,and the difference were statistically significant(P<0.05).In this study,the thickness of the lower uterine muscle of pregnant women in the vaginal delivery group was smaller than that of the cesarean section.The thickness of the lower anterior uterine muscular layer of the scars in different gestational weeks detected by ultrasound was different(P<0.05),and the thickness of the lower uterine muscular layer gradually decreased with the increasing of gestational age;the two groups of different gestational weeks of the lower anterior muscular layer The difference in continuity was not statistically significant(P>0.05).Conclusion:Ultrasound examination of the continuity of the lower uterus can be used as a reference f

关 键 词：子宫下段厚度及连续性 超声检查 剖宫产术后再次妊娠 

分 类 号：R714[医药卫生—妇产科学]