前壁下段瘢痕子宫形态结构改变的全容积超声观察对先兆子宫破裂的预测应用价值分析
摘要
目的探讨全自动容积超声检测子宫瘢痕前壁下段厚度在预测先兆子宫破裂中的应用价值,为早期发现先兆子宫破裂、指导临床选择合适的分娩方式提供参考。方法选取2015年1月-2017年11月海口市妇幼保健院收治的中晚期子宫瘢痕孕妇188例,均采用全自动容积超声检测子宫瘢痕前壁下段厚度,按照子宫瘢痕分级将孕妇分为Ⅰ度组97例、Ⅱ度组63例、Ⅲ度组28例,观察3组孕妇孕32、36、39周时前壁下段厚度变化,比较3组孕妇阴道试产成功率、先兆子宫破裂发生率;分析子宫瘢痕前壁下段厚度变化对预测先兆子宫破裂中的价值。结果不同检测时间点Ⅰ度组孕妇子宫瘢痕前壁下段厚度明显大于Ⅱ度组和Ⅲ度组,差异有统计学意义(P<0. 05);同组孕妇随着孕周增加,子宫瘢痕前壁下段厚度逐渐变薄,组内比较差异有统计学意义(P<0. 05)。阴道试产成功率和先兆子宫破裂发生率Ⅰ度组为98. 97%和1. 03%、Ⅱ度组为95. 24%和4. 76%、Ⅲ度组为46. 43%和53. 57%,3组差异有统计学意义(P<0. 05)。子宫瘢痕前壁下段肌层低回声结构改变和全层厚度在预测先兆子宫破裂的ROC曲线下面积分别为0. 946和0. 887,差异有统计学意义(P<0. 05)。前壁下段肌层低回声结构改变在预测先兆子宫破裂的灵敏度94. 74%,特异度100. 00%,准确度99. 47%,阳性预测值99. 41%,阴性预测值100. 00%。结论全自动容积超声检测不同时期子宫瘢痕前壁下段厚度有助于早期发现先兆子宫破裂,指导临床选择合适的分娩方式。
引文
[1]梁亚霞,梁燕.超声检测中晚期子宫瘢痕前壁下段厚度在临床阴道试产及先兆子宫破裂中的意义[J].中国现代药物应用,2017,11(9):6-8.
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[16]李鸿雁.超声全程检测剖宫产术后再次妊娠子宫瘢痕变化的临床意义[J].实用临床医药杂志,2014,18(23):203-204.
[17]中华医学会妇产科学分会产科学组.剖宫产术后再次妊娠阴道分娩管理的专家共识(2016)[J].中华妇产科学杂志,2016,51(8):561-564.
[18]Yu L,Su CH,Wang XY,et al.Multi-centric clinical study of trial of labor after cesarean section[J].Zhonghua Fu Chan Ke Za Zhi,2016,51(8):581-585.
[19]郭稳,陈涛,高侃,等.自动全容积扫查技术在手掌部超声检查中的初步应用[J].中国超声医学杂志,2015,31(8):725-727.
[20]Surico D,Amadori R,Vigone A,D'Agostino C,Dessole M,Surico N.Successful delivery after surgical repair of uterine rupture at 15 weeks of gestation:case report and brief review[J].Eur JObstet Gynecol Reprod Biol,2016,204():5-8.
[2]许杨青,陈欣林,杨小红,等.全自动容积超声观察子宫瘢痕结构改变预测先兆子宫破裂的价值研究[J].中国超声医学杂志,2017,33(1):45-47.
[3]Vigoureux S,Fernandez H,Capmas P,et al.Assessment of Abdominal Ultrasound Guidance in Hysteroscopic Metroplasty[J].J Minim Invasive Gynecol,2016,23(1):78-83.
[4]Farooq F,Siraj R,Raza S,Saif N.Spontaneous Uterine Rupture Due to Placenta Percreta in a 17-Week Twin Pregnancy[J].J Coll Physicians Surg Pak,2016,26(11):121-123.
[5]Coste MP,Catalan C,Eyraud JL,Aubard Y,Gauthier T.Cervical ripening after previous cesarean section with dinoprostone vaginal insert[J].Gynecol Obstet Fertil Senol,2017,45(2):77-82.
[6]毕娟,洪向丽.超声测量中晚期子宫瘢痕前壁下段厚度对阴道试产及先兆子宫破裂的临床意义[J].中国计划生育与妇产科,2016,8(5):55-57.
[7]王颖芳,陈欣林,肖梅,等.超声自动全容积扫查系统测量晚孕期瘢痕子宫前壁下段肌层厚度[J].中国医学影像技术,2016,32(6):927-931.
[8]Langhe R,Shah UF,Alfathil A,Gannon M.Silent uterine rupture in scarred uterus[J].BMJ Case Rep,2017:2017.
[9]Vachon-Marceau C,Demers S,Bujold E,et al.Single versus double-layer uterine closure at cesarean:impact on lower uterine segment thickness at next pregnancy[J].Am J Obstet Gynecol,2017,217(1):65.e1-65.e5.
[10]余亚婷,汪涵,宋启敏,等.高频超声检查在瘢痕子宫再次妊娠晚期患者分娩方式选择中的应用价值[J].中华全科医学,2017,15(9):1629-1631.
[11]许杨青,陈欣林,杨小红,等.全自动容积成像系统和二维超声测量瘢痕子宫前壁下段厚度的对比研究[J].中国超声医学杂志,2016,32(1):67-69.
[12]彭祥菊.145例疤痕子宫再次妊娠分娩方式的探讨[J].中国公共卫生,2015,31(A02):187-188.
[13]Spain JA,Shaikh S,Sandberg SA.Sonographic Findings and Diagnostic Pitfalls in Evaluation for Uterine Rupture in a Case of Fetal Demise and Prior Cesarean Delivery of Unknown Type[J].Ultrasound Q,2017,33(1):69-73.
[14]Baeza C,Mottet N,Coppola C,Desmarets M,Ramanah R,Riethmuller D.Obstetrical prognosis of patients after a previous caesarean section performed before 32 weeks of amenorrhea[J].Gynecol Obstet Fertil,2016,44(11):629-635.
[15]Ziegler N,Korell M,Herrmann A,et al.Uterine perforation following a fractional curettage successfully treated with the modified polysaccharide 4Dry FieldPH:a case report[J].J Med Case Rep,2016,10(1):243.
[16]李鸿雁.超声全程检测剖宫产术后再次妊娠子宫瘢痕变化的临床意义[J].实用临床医药杂志,2014,18(23):203-204.
[17]中华医学会妇产科学分会产科学组.剖宫产术后再次妊娠阴道分娩管理的专家共识(2016)[J].中华妇产科学杂志,2016,51(8):561-564.
[18]Yu L,Su CH,Wang XY,et al.Multi-centric clinical study of trial of labor after cesarean section[J].Zhonghua Fu Chan Ke Za Zhi,2016,51(8):581-585.
[19]郭稳,陈涛,高侃,等.自动全容积扫查技术在手掌部超声检查中的初步应用[J].中国超声医学杂志,2015,31(8):725-727.
[20]Surico D,Amadori R,Vigone A,D'Agostino C,Dessole M,Surico N.Successful delivery after surgical repair of uterine rupture at 15 weeks of gestation:case report and brief review[J].Eur JObstet Gynecol Reprod Biol,2016,204():5-8.