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目的探讨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。方法选取2013年8月至2015年7月同济大学附属第一妇婴保健院收治的中晚期子宫瘢痕孕妇136例,采用彩色超声技术观察子宫瘢痕形态及测量前壁下段厚度,根据子宫瘢痕等级分为3组,Ⅰ级瘢痕组84例,Ⅱ级瘢痕组30例,Ⅲ级瘢痕组22例,观察3种子宫瘢痕等级孕妇的妊娠结局。结果 34周、36周、38周、40周Ⅰ级子宫瘢痕孕妇的瘢痕前壁下段厚度(4.39±0.10,4.21±0.14,4.03±0.16,3.26±0.19)均显著高于Ⅱ、Ⅲ级子宫瘢痕的厚度(2.71±0.20,2.15±0.28,2.01±0.35,1.97±0.34),差异有统计学意义(P<0.05);随着孕周的增加,Ⅰ、Ⅱ、Ⅲ级瘢痕前壁下段厚度也逐渐变薄(P<0.05);随着子宫瘢痕等级的增加,孕妇阴道试产成功率逐渐下降,先兆子宫破裂的发生率逐渐升高,差异有统计学意义(P<0.05)。结论超声检测中晚期子宫瘢痕前壁下段厚度,对临床阴道试产及先兆子宫破裂具有一定的指导意义。
Objective To investigate the clinical significance of measuring the thickness of the anterior wall of the uterine scar with ultrasound in the trial of vaginal delivery and the diagnosis of threatened uterine rupture. Methods From August 2013 to July 2015, 136 pregnant women with advanced uterine scar were admitted to the First Affiliated Maternal and Infant Hospital of Tongji University. The uterine scar morphology was observed by color sonography and the thickness of the anterior wall was measured. According to the uterine scar rating There were 84 cases in grade Ⅰ scar group, 30 cases in grade Ⅱ scar group and 22 cases in grade Ⅲ scar group. The pregnancy outcomes of 3 kinds of uterine scar-level pregnant women were observed. Results The thickness of lower anterior segment of the anterior scar in pregnant women with grade Ⅰ uterine scar at 34 weeks, 36 weeks, 38 weeks and 40 weeks were significantly higher than those in grades Ⅱ and Ⅲ (4.39 ± 0.10, 4.21 ± 0.14, 4.03 ± 0.16, 3.26 ± 0.19) (2.71 ± 0.20,2.15 ± 0.28,2.01 ± 0.35,1.97 ± 0.34), the difference was statistically significant (P <0.05). With the increase of gestational age, the thickness of lower anterior wall of grade Ⅰ, Ⅱ, Ⅲ (P <0.05). With the increase of uterine scar level, the success rate of vaginal trial production gradually decreased and the incidence of threatened uterine rupture gradually increased (P <0.05). Conclusion Ultrasound examination of the lower uterine scar in the anterior wall thickness of the vagina, clinical vaginal trial and threatened uterine rupture has some guiding significance.