彩色多普勒超声对子宫切口妊娠的诊断价值及瘢痕厚度对剖宫产后再妊娠结局的预测意义
|
摘要
目的探讨彩色多普勒超声对子宫切口妊娠的诊断价值及对瘢痕厚度剖宫产后再妊娠结局的预测意义。方法选择2017年1—10月子宫切口妊娠75例作为观察组,选择同期有剖宫产手术史正常妊娠者75例作为对照组。观察2组超声影像区别。收集对照组孕24周以上的超声影像资料,根据瘢痕厚度分为Ⅰ级(38例)、Ⅱ级(19例)、Ⅲ级(11例)和Ⅳ级(7例),观察不同分级孕妇妊娠结局。结果观察组宫腔内异常回声率低于对照组,切口肌层厚度薄于对照组,孕囊与切口距离小于对照组,血流指数低于对照组(P <0. 05)。对照组瘢痕厚度不同分级孕妇分娩期缩宫素用量、出血量及产后并发症发生率差异有统计学意义(P <0. 05)。结论超声检查子宫切口妊娠可明确子宫瘢痕的缺陷,可根据瘢痕厚度及时预测子宫破裂、出血和感染的风险。
Objective To investigate value of color Doppler ultrasound in diagnosis of uterine incision pregnancy and predictive significance of cicatrix thickness for re-pregnancy outcome after cesarean section. Methods A total of 75 patients with uterine incision pregnancy during January 2017 and October 2017 were selected as observation group,while other 75 women of normal pregnancy with cesarean section history at the same period were selected as control group.Differences of ultrasound images were observed between two groups. In control group,ultrasonographic informations of over 24 weeks of pregnancy were collected,and the women were divided into grade Ⅰ subgroup(n = 38),grade Ⅱ subgroup(n = 19),grade Ⅲ subgroup(n = 11) and grade Ⅳ subgroup(n = 7) according to scar thickness,and then pregnancy outcomes of subgroups were observed. Results Compared with those in control group,in observation group,abnormal echo rate of uterine cavity was significantly lower,and thickness of incisional myometrium was more thinner,and distance between gestational sac and incision was shorter,and value of blood flow index was significantly lower(P <0. 05). There were significant differences in dosages of oxytocin use during delivery period,bleeding volume and incidence rate of postpartum complication among cicatrix thickness subgroups(P < 0. 05). Conclusion Ultrasonography for uterine incision pregnancy may identifies defects of uterine scar and predict risks such as uterine rupture,bleeding and infection in time.
Objective To investigate value of color Doppler ultrasound in diagnosis of uterine incision pregnancy and predictive significance of cicatrix thickness for re-pregnancy outcome after cesarean section. Methods A total of 75 patients with uterine incision pregnancy during January 2017 and October 2017 were selected as observation group,while other 75 women of normal pregnancy with cesarean section history at the same period were selected as control group.Differences of ultrasound images were observed between two groups. In control group,ultrasonographic informations of over 24 weeks of pregnancy were collected,and the women were divided into grade Ⅰ subgroup(n = 38),grade Ⅱ subgroup(n = 19),grade Ⅲ subgroup(n = 11) and grade Ⅳ subgroup(n = 7) according to scar thickness,and then pregnancy outcomes of subgroups were observed. Results Compared with those in control group,in observation group,abnormal echo rate of uterine cavity was significantly lower,and thickness of incisional myometrium was more thinner,and distance between gestational sac and incision was shorter,and value of blood flow index was significantly lower(P <0. 05). There were significant differences in dosages of oxytocin use during delivery period,bleeding volume and incidence rate of postpartum complication among cicatrix thickness subgroups(P < 0. 05). Conclusion Ultrasonography for uterine incision pregnancy may identifies defects of uterine scar and predict risks such as uterine rupture,bleeding and infection in time.
引文
[1]贾书方,李静,杨春华.瘢痕子宫产妇二次剖宫产并发症发生情况及与非瘢痕子宫剖宫产的对照研究[J].中国妇幼保健,2016,31(1):65-66.
[2] Sturzenegger K,Schaffer L,Zimmermann R,et al. Risk factors of uterine rupture with a special interest to uterine fundal pressure[J]. J Perinat Med,2017,45(3):309-313.
[3]黎媛君.经腹经阴道彩色多普勒超声联合诊断剖宫产子宫切口瘢痕妊娠的应用价值[J].实用医技杂志,2017,24(10):1068-1069.
[4]王倩,白海艳,王妮妮.彩色多普勒超声检查剖宫产术后子宫切口妊娠的临床价值[J].医学影像学杂志,2016,26(2):372-374.
[5]李艳彬,孟雷,赵雅萍,等.经阴道超声联合磁共振对剖宫产术后子宫瘢痕妊娠的诊断价值[J].医学研究杂志,2017,46(2):74-77.
[6]景磊,郭晓莉.经阴道超声在诊断剖宫产后子宫瘢痕处妊娠的临床应用价值探讨[J].延安大学学报:医学科学版,2015,13(4):41-42.
[7]于海容,康杰,韦娜,等.彩色多普勒超声检查在剖宫产术后子宫瘢痕妊娠诊断及治疗中的应用[J].山东医药,2015,55(11):46-47.
[8]刘智霞.经阴道超声与MRI在剖宫产术后早期子宫瘢痕妊娠中的诊断分析[J].世界最新医学信息文摘,2016,16(96):275-276.
[9]金梅峰.剖宫产术后瘢痕妊娠的血管介入治疗[J].血管与腔内血管外科杂志,2015,1(Z1):161-163.
[10]翟建茹.子宫切口妊娠的超声诊断及临床价值[J].医学理论与实践,2015,28(13):1783-1784.
[11] Wang D B,Chen Y H,Zhang Z F,et al. Evaluation of the transvaginal resection of low-segment cesarean scar ectopic pregnancies[J]. Fertil Steril,2014,101(2):602-606.
[12]陈基强,刘欣友,李运芳,等.彩色多普勒超声对剖宫产术后子宫切口妊娠的诊断及临床价值研究[J].医学综述,2013,19(14):2654-2655.
[13]王爱红.彩色多普勒超声在剖宫产术后子宫切口妊娠中的诊断价值[J].深圳中西医结合杂志,2015,25(3):39-40.
[14]丁吉丽.超声介入下注射聚桂醇联合宫腔镜下清宫术治疗剖宫产术后子宫瘢痕妊娠12例[J].中国乡村医药,2016,23(17):24-25.
[15]罗艳娣,孙颉.经腹超声和经阴道超声对剖宫产术后子宫瘢痕妊娠的诊断价值比较[J].中国妇幼保健,2017,32(8):1788-1790.
[16]南瑞霞,万映,华少萍,等.腹部超声诊断剖宫产后再次妊娠子宫疤痕破裂的临床研究[J].中国现代医学杂志,2016,26(5):98-100.
[17]彭文通,何远明.彩色多普勒超声在子宫切口妊娠诊断与治疗中的应用[J].实用医院临床杂志,2014,11(6):145-147.
[18]申启玲,邓波.超声对剖宫产术后子宫切口妊娠的诊断价值[J].临床超声医学杂志,2012,14(6):415-416.
[2] Sturzenegger K,Schaffer L,Zimmermann R,et al. Risk factors of uterine rupture with a special interest to uterine fundal pressure[J]. J Perinat Med,2017,45(3):309-313.
[3]黎媛君.经腹经阴道彩色多普勒超声联合诊断剖宫产子宫切口瘢痕妊娠的应用价值[J].实用医技杂志,2017,24(10):1068-1069.
[4]王倩,白海艳,王妮妮.彩色多普勒超声检查剖宫产术后子宫切口妊娠的临床价值[J].医学影像学杂志,2016,26(2):372-374.
[5]李艳彬,孟雷,赵雅萍,等.经阴道超声联合磁共振对剖宫产术后子宫瘢痕妊娠的诊断价值[J].医学研究杂志,2017,46(2):74-77.
[6]景磊,郭晓莉.经阴道超声在诊断剖宫产后子宫瘢痕处妊娠的临床应用价值探讨[J].延安大学学报:医学科学版,2015,13(4):41-42.
[7]于海容,康杰,韦娜,等.彩色多普勒超声检查在剖宫产术后子宫瘢痕妊娠诊断及治疗中的应用[J].山东医药,2015,55(11):46-47.
[8]刘智霞.经阴道超声与MRI在剖宫产术后早期子宫瘢痕妊娠中的诊断分析[J].世界最新医学信息文摘,2016,16(96):275-276.
[9]金梅峰.剖宫产术后瘢痕妊娠的血管介入治疗[J].血管与腔内血管外科杂志,2015,1(Z1):161-163.
[10]翟建茹.子宫切口妊娠的超声诊断及临床价值[J].医学理论与实践,2015,28(13):1783-1784.
[11] Wang D B,Chen Y H,Zhang Z F,et al. Evaluation of the transvaginal resection of low-segment cesarean scar ectopic pregnancies[J]. Fertil Steril,2014,101(2):602-606.
[12]陈基强,刘欣友,李运芳,等.彩色多普勒超声对剖宫产术后子宫切口妊娠的诊断及临床价值研究[J].医学综述,2013,19(14):2654-2655.
[13]王爱红.彩色多普勒超声在剖宫产术后子宫切口妊娠中的诊断价值[J].深圳中西医结合杂志,2015,25(3):39-40.
[14]丁吉丽.超声介入下注射聚桂醇联合宫腔镜下清宫术治疗剖宫产术后子宫瘢痕妊娠12例[J].中国乡村医药,2016,23(17):24-25.
[15]罗艳娣,孙颉.经腹超声和经阴道超声对剖宫产术后子宫瘢痕妊娠的诊断价值比较[J].中国妇幼保健,2017,32(8):1788-1790.
[16]南瑞霞,万映,华少萍,等.腹部超声诊断剖宫产后再次妊娠子宫疤痕破裂的临床研究[J].中国现代医学杂志,2016,26(5):98-100.
[17]彭文通,何远明.彩色多普勒超声在子宫切口妊娠诊断与治疗中的应用[J].实用医院临床杂志,2014,11(6):145-147.
[18]申启玲,邓波.超声对剖宫产术后子宫切口妊娠的诊断价值[J].临床超声医学杂志,2012,14(6):415-416.