经腹超声测量瘢痕子宫下段全层厚度预测不完全性子宫破裂的临床价值  

Clinical value of transabdominal ultrasound in predicting incomplete uterine rupture

作　　者：施旻玥 罗婷 张春红 SHI Min-yue;LUO Ting;ZHANG Chun-hong(Department of Obstetrics and Gynecology,First Maternal and Infant Health Hospital,Tongji University,Shanghai 201204,China.)

机构地区：[1]同济大学附属第一妇婴保健院妇产科,上海201204

出　　处：《临床和实验医学杂志》2022年第24期2628-2631,共4页Journal of Clinical and Experimental Medicine

基　　金：上海市自然科学基金项目(编号:20ZR1443900)。

摘　　要：目的 探讨经腹超声测量瘢痕子宫下段全层厚度预测不完全性子宫破裂的临床价值。方法 回顾性选取2020年5月至2021年8月入同济大学附属第一妇婴保健院行剖宫产的子宫瘢痕孕妇167例作为研究对象,按照子宫瘢痕分级进行分组,共计分3组,Ⅰ级86例,Ⅱ级58例,Ⅲ级23例。对不同等级子宫瘢痕孕妇临床资料进行对比分析;观察孕36周、38周和40周子宫瘢痕孕妇子宫下段全层厚度变化情况;记录不同等级子宫瘢痕孕妇发生不完全性子宫破裂情况;采用受试者工作特征(ROC)曲线分析经腹超声测量瘢痕子宫下段全层厚度对不完全性子宫破裂的诊断价值。结果 Ⅰ级、Ⅱ级和Ⅲ级子宫瘢痕孕妇的平均年龄、体重指数、孕周、羊水指数和两次生产间隔比较,差异均无统计学意义(P>0.05);Ⅱ级孕36、38、40周的子宫瘢痕孕妇子宫下段全层厚度为(2.96±0.73)、(2.78±0.64)、(2.65±0.59) mm,显著低于Ⅰ级(4.83±0.86、4.76±0.79、4.57±0.21) mm,差异均有统计学意义(P<0.05),Ⅲ级孕36、38、40周的子宫瘢痕孕妇子宫下段全层厚度为(2.06±0.49)、(1.85±0.41)、(1.64±0.37) mm,显著低于Ⅱ级,差异均有统计学意义(P<0.05);Ⅲ级子宫瘢痕孕妇不完全性子宫破裂的发生率为(52.17%),明显高于Ⅰ级(1.16%)和Ⅱ级(5.17%)子宫瘢痕孕妇,差异均有统计学意义(P<0.05)。子宫下段全层厚度预测不完全性子宫破裂的最佳临界值为3.26 mm,当最佳临界值为3.26 mm时,ROC曲线下面积为0.864(95%CI:0.742~0.985,P<0.001),敏感度为81.25%,特异度为78.15%。结论 经腹超声测量不同孕期瘢痕子宫下段全层厚度有利于指导发现不完全性子宫破裂情况,预测不完全性子宫破裂的发生更具有实用价值,对于指导临床诊治具有积极意义。Objective To explore the clinical value of transabdominal ultrasound in predicting incomplete uterine rupture.Methods A total of 167 pregnant women with uterine scar who underwent cesarean section in the first maternal and Infant Health Hospital Affiliated to Tongji University from May 2020 to August 2021 were retrospectively selected. They were divided into three groups according to the grading of uterine scar, including 86 cases of grade Ⅰ, 58 cases of grade Ⅱ and 23 cases of grade Ⅲ. The clinical data of pregnant women with different grades of uterine scar were compared and analyzed;The changes of the whole thickness of the lower segment of the uterus in pregnant women with uterine scar at 36, 38 and 40 weeks were observed;The occurrence of incomplete uterine rupture in pregnant women with different grades of uterine scar was recorded;The receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of transabdominal ultrasound in measuring the full thickness of the lower segment of scar uterus for incomplete uterine rupture.Results There was no significant difference in average age, BMI, gestational weeks, amniotic fluid index and two birth intervals among pregnant women with grade Ⅰ, Ⅱand Ⅲ uterine scars(P>0.05). The whole thickness of the lower part of the uterus of pregnant women with grade Ⅱ uterine scar at 36, 38 and 40 weeks were(2.96±0.73),(2.78±0.64),(2.65±0.59) mm, which were significantly lower than those of grade Ⅰ[(4.83±0.86),(4.76±0.79),(4.57±0.21) mm], the differences were statistically significant(P<0.05). The whole thickness of the lower part of the uterus of pregnant women with grade Ⅲ uterine scar at 36, 38 and 40 weeks were(2.06±0.49),(1.85±0.41),(1.64±0.37) mm, which were significantly lower than that of grade Ⅱ, the differences were statistically significant(P<0.05). The incidence of incomplete uterine rupture in pregnant women with grade Ⅲ uterine scar was 52.17%,significantly higher than that in pregnant women with grade Ⅰ(1.16%),

关 键 词：不完全性子宫破裂 经腹超声 瘢痕子宫 下段全层厚度 预测 

分 类 号：R711.74[医药卫生—妇产科学]