经阴道超声测量剖宫产术后再次妊娠女性孕晚期子宫前壁下段厚度的临床价值  

Clinical value of transvaginal ultrasound in measuring the thickness of the lower segment of the anterior wall of the uterus in the second trimester after caesarean section

作　　者：邓宇鲲[1] 陈涛[1] 赵一冰[1] Deng Yukun;Chen Tao;Zhao Yibing(Department of Ultrasound,Beijing Jishuitan Hospital,Beijing 102208,China)

机构地区：[1]北京积水潭医院超声科,北京102208

出　　处：《中国医刊》2022年第11期1207-1210,共4页Chinese Journal of Medicine

基　　金：北京积水潭医院院级科研基金(2019-YJ05)。

摘　　要：目的探讨经阴道超声测量剖宫产术后再次妊娠女性孕晚期子宫前壁下段厚度的临床价值。方法选取北京积水潭医院2018年1月至2020年1月收治的剖宫产后再次妊娠女性296例,采用经阴道超声在纵切面及横切面显示子宫下段前壁最薄处,放大局部图像,连续测量3次,计算测量厚度的平均值并记录留图。结果296例孕妇中,产次2次者287例,其中阴道分娩61例,剖宫产226例;产次3次者9例,均再次剖宫产。超声提示237例孕妇子宫下段厚度≥2.0mm,其中56例(23.6%)阴道分娩,181例(76.4%)剖宫产;子宫下段厚度<2.0mm者59例,5例(8.5%)阴道分娩,54例(91.5%)剖宫产。产次2次的孕妇中子宫下段瘢痕破裂1例(0.35%),子宫下段瘢痕撕裂3例(1.05%)。剖宫产孕妇子宫下段厚度≥2.0mm组术前超声检查与术中实际测量符合率低于<2.0mm组,差异有显著性(P<0.05)。不同子宫下段厚度的孕妇阴道分娩比例差异有显著性(P<0.05),且随着厚度增大阴道分娩比例增加。结论经阴道超声检查测量的子宫前壁下段厚度与临床诊断的符合率较高,对孕妇分娩方式的选择具有一定的指导意义。对于瘢痕缺损的孕妇建议及时进行剖宫产结束分娩,可有效避免剖宫产术后因再次妊娠导致瘢痕破裂或撕裂的发生。Objective To explore the clinical value of transvaginal ultrasonography in the measurement of the thickness of the lower segment of the anterior wall of uterus in late pregnancy after cesarean section.Method A total of 296 pregnant women who were pregnant again after laparotomy in our hospital from January 2018 to January 2020 were collected,transvaginal ultrasound showed the thinnest part of the anterior wall of the lower segment of the uterus on both longitudinal and transverse sections,zoom in locally,three times in a row,calculate the average of the measured thickness and record the retention chart.Result 287 cases were delivered twice,including 61 cases of vaginal delivery and 226 cases of cesarean section;there were 9 cases of 3 times of labor,all of which were delivered by caesarean section again.Ultrasound showed that the thickness of the lower uterine segment of 237 pregnant women was≥2.0mm,of which 56(23.6%)had vaginal delivery and 181(76.4%)had cesarean section;the thickness of lower uterine segment was less than 2.0mm in 59 cases,5 cases(8.5%)had vaginal delivery and 54 cases(91.5%)had cesarean section.Among the pregnant women with two deliveries,1 case(0.35%)had scar rupture of the lower uterine segment and 3 cases(1.05%)had scar tear of the lower uterine segment.The coincidence rate between preoperative ultrasound examination and intraoperative measurement in the group with thickness of lower uterine segment≥2.0mm in cesarean section was lower than that in the group with thickness of lower uterine segment<2.0mm,with significant difference(P<0.05).The proportion of vaginal delivery with different thickness was significantly different(P<0.05),and the proportion of vaginal delivery increased with the increase of thickness.Conclusion The measurement of the thickness of the lower segment of the anterior wall of the uterus by transvaginal ultrasound has a relatively high coincidence rate with the clinical diagnosis,which has a certain guiding significance for the selection of the delivery mode of preg

关 键 词：剖宫产 妊娠 子宫前壁下段厚度 

分 类 号：R445[医药卫生—影像医学与核医学]