经腹联合经阴道超声检测瘢痕子宫下段肌层厚度对分娩方式选择的指导价值
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摘要
目的分析经腹联合经阴道超声检测瘢痕子宫下段肌层厚度对分娩方式选择的指导价值。方法选择我院收治的100例剖宫产再次妊娠孕妇为研究组,同期收集90例既往无剖宫产史的妊娠孕妇为对照组。均接受经腹联合经阴道超声检查,比较瘢痕显影、切口愈合情况、不同瘢痕分级者子宫下段肌层厚度、对照组和研究组分娩结局。结果在对照组中,经腹联合经阴道超声未检出瘢痕,经腹超声和经腹联合经阴道超声检出子宫下段肌层厚度差异无统计学意义(P>0.05)。在研究中,联合超声组瘢痕显影率及Ⅰ级瘢痕率高于经腹超声(P<0.05),Ⅳ级子宫下段肌层厚度均低于Ⅲ、Ⅱ级及Ⅰ级,联合超声组瘢痕子宫下段肌层厚度显著低于经腹超声(P<0.05)。与对照组比,研究组两组阴道分娩率均高于剖宫产率,但差异无统计学意义(P>0.05);联合阴道超声组阴道分娩率高于对照组(P<0.05)。结论经腹联合经阴道超声检测子宫下段肌层厚度的显影率高,评估瘢痕情况有利于临床分娩方案的制定。
Objective To analyze the guiding value of abdominal and transvaginal ultrasonography in the selection of delivery methods for detecting scar subuterine muscle layer thickness.Methods From 100 casessecond pregnancy after cesarean section were collected into the study group,90 pregnant women who had no previous cesarean section were selected as the control group.All patients received trans-abdominal and transvaginal ultrasonography,and the scar development,wound healing,and the thickness of the subuterine muscle layer of patients with different scar grades,and the outcome of childbirthof 2 groups was compared.Results In the control group,no scar was detected by transabdominal combined transvaginal ultrasound,and there had no significant difference in the thickness of the lower uterine segment between the transabdominal ultrasound and transabdominal transvaginal ultrasound(P>0.05).In the observation group,the scar imaging rate and grade I scar rate in the combined ultrasound group were higher than those in the transabdominal ultrasound(P<0.05),and the thickness of theⅣlower uterine segment was lower thanⅢ,Ⅱ andⅠgrade.Muscle layer thickness was significantly lower than transabdominal ultrasound(P<0.05).Compared with the control group,the vaginal delivery rate of the observation group was higher than the cesarean section rate,but the difference was not statistically significant(P>0.05).The vaginal delivery rate of the combined vaginal ultrasound group was higher than that of the control group(P<0.05).Conclusions Development rate of the subuterine muscle layer is highly by transabdominal combined withtransvaginal ultrasonography,and to evaluate the scar situation is beneficial to the development of clinical delivery program.
Objective To analyze the guiding value of abdominal and transvaginal ultrasonography in the selection of delivery methods for detecting scar subuterine muscle layer thickness.Methods From 100 casessecond pregnancy after cesarean section were collected into the study group,90 pregnant women who had no previous cesarean section were selected as the control group.All patients received trans-abdominal and transvaginal ultrasonography,and the scar development,wound healing,and the thickness of the subuterine muscle layer of patients with different scar grades,and the outcome of childbirthof 2 groups was compared.Results In the control group,no scar was detected by transabdominal combined transvaginal ultrasound,and there had no significant difference in the thickness of the lower uterine segment between the transabdominal ultrasound and transabdominal transvaginal ultrasound(P>0.05).In the observation group,the scar imaging rate and grade I scar rate in the combined ultrasound group were higher than those in the transabdominal ultrasound(P<0.05),and the thickness of theⅣlower uterine segment was lower thanⅢ,Ⅱ andⅠgrade.Muscle layer thickness was significantly lower than transabdominal ultrasound(P<0.05).Compared with the control group,the vaginal delivery rate of the observation group was higher than the cesarean section rate,but the difference was not statistically significant(P>0.05).The vaginal delivery rate of the combined vaginal ultrasound group was higher than that of the control group(P<0.05).Conclusions Development rate of the subuterine muscle layer is highly by transabdominal combined withtransvaginal ultrasonography,and to evaluate the scar situation is beneficial to the development of clinical delivery program.
引文
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[2]ROY M M,RADFAR F.Management of a Viable CesareanScarPregnancy:A Case Report[J].Oman Med J,2017,32(2):161-166.
[3]王秋平,闫翠云.超声监测妊娠期瘢痕子宫下段肌层厚度的意义[J].中国药物与临床,2014,14(12):1715-1716.
[4]GONZALEZ N,TULANDI T.CesareanScarPregnancy:A Systematic Review[J].J Minim Invasive Gynecol,2017,24(5):731-738.
[5]柯茹,夏俊霞,田青平,等.超声检测孕晚期子宫下段全层厚度对瘢痕子宫再次妊娠分娩的临床价值[J].临床和实验医学杂志,2014,13(5):400-403.
[6]吴秋芬,胡燕.经腹联合经会阴超声对子宫下段瘢痕愈合情况的检测及对再次妊娠分娩方式选择的指导意义[J].中国妇幼保健,2014,29(8):1192-1194.
[7]洪莲,万映,关莹,等.妊娠中、晚期经阴道超声检测子宫瘢痕前壁下段厚度的价值比较[J].重庆医学,2017,46(34):4841-4843.
[8]MOSAD A,ALTRAIGEY A.Scarpregnancy and spontaneous ruptureuterus-a case report[J].Ginekol Pol,2017,88(12):698-699.
[9]王新彦,李洪霞,冀涛.不同程度瘢痕子宫对再次妊娠子宫下段厚度及分娩方式选择的影响[J].医学综述,2017,23(4):814-816.
[10]冯建丽.瘢痕子宫妊娠晚期子宫下段瘢痕厚度与分娩方式的相关性研究[J].中国妇幼保健,2017,32(7):1429-1431.