摘要
目的评价超声测量子宫下段肌层厚度对子宫瘢痕愈合不良的预测价值,并分析子宫瘢痕愈合不良的高危因素。方法选取2019年1-6月于北部战区总医院和平分院住院择期重复剖宫产(ERCD)孕妇323例,于术前1~3 d应用经腹高频超声测量子宫下段肌层厚度与术中肉眼所见子宫瘢痕愈合情况对比,通过ROC曲线确定预测子宫瘢痕愈合不良的子宫下段肌层厚度最佳截断值,单因素及多因素Logistic回归分析子宫瘢痕愈合不良的高危因素。结果 323例ERCD产妇术中所见子宫瘢痕愈合Ⅰ级者263例占81.4%,Ⅱ级者52例占16.1%,Ⅲ级者8例占2.5%,子宫瘢痕愈合不良发生率为18.6%。ROC曲线显示超声测量子宫下段肌层厚度可以较好地预测子宫瘢痕愈合不良,计算得出最佳截断值为1.2 mm。子宫下段肌层厚度≤1.2 mm、此次新生儿体质量偏大、前次剖宫产为早产是影响子宫瘢痕愈合不良的危险因素,差异有统计学意义(P<0.05)。结论超声测量剖宫产术后再次妊娠孕晚期子宫下段肌层厚度可以帮助判断子宫瘢痕愈合情况,并为分娩方式的选择提供依据,提高TOLAC安全性。
Objective To evaluate the value of lower uterine segment thickness measured by ultrasound in prediction of cesarean scar undesirable healing,analyze high-risk factors of cesarean scar defect.Methods From January to June in 2019,323 pregnant women of elective repeat cesarean delivery(ERCD)were selected from General Hospital of Northern Theater Command,transabdominal high-frequency ultrasound was used to measure lower uterine segment thickness at 1-3 days before surgery,then the results were compared with naked uterine scar seen by the surgeon during cesarean section,ROC curve was used to confirm the optimal cutoff value of lower uterine segment thickness in prediction of cesarean scar defect.Univariate analysis and multivariate Logistic regression analysis were used to analyze the high-risk factors of cesarean scar defect.Results Among 323 pregnant women,degreeⅠwound healing was observed in 263 pregnant women,accounting for 81.4%,degreeⅡwound healing was observed in 52 pregnant women,accounting for 16.1%,degreeⅢwound healing was observed in 8 pregnant women,accounting for 2.5%,the incidence rate of undesirable healing of cesarean scar was 18.6%.ROC curve showed that lower uterine segment thickness measured by ultrasound could predict cesarean scar defect,the optimal cutoff value was 1.2 mm.Lower uterine segment thickness≤1.2 mm,high weight of neonate,premature delivery of the previous cesarean section were risk factors of cesarean scar defect(P<0.05).Conclusion Lower uterine segment thickness measured by ultrasound during the third trimester of pregnancy after previous cesarean section can help to judge healing of cesarean scar,which can provide a basis for selection of delivery modes and improvement of TOLAC safety.
作者
仲莞
陈震宇
孙静莉
金珈汐
ZHONG Wan;CHEN Zhen-Yu;SUN Jing-Li(General Hospital of Northern Theater Command,China Medical University,Shenyang,Liaoning 110003,China)
出处
《中国妇幼保健》
CAS
2021年第1期198-202,共5页
Maternal and Child Health Care of China
基金
辽宁省自然科学基金项目(20180551133)。
关键词
重复剖宫产
子宫下段
剖宫产瘢痕
高频超声
危险因素
Elective repeat cesarean delivery
Lower uterine segment
Cesarean scar
High-frequency ultrasound
Risk factor
