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目的观察剖宫产产妇再次妊娠子宫下段的超声影像学特征及临床价值。方法选取2012年10月-2014年6月于成都市第一人民医院接受超声检查的800例产妇。将400例有剖宫产史者(均于子宫下段做横切口行剖宫产)设为观察组,200例顺产后再次妊娠的产妇设为对照Ⅰ组,200例初产妇设为对照Ⅱ组。3组产妇均在超声检查下观察其子宫下段的特征,并测量子宫下段的肌层厚度。结果观察组产妇的瘢痕位置在超声检查过程中有低回声肌层局部明显变薄、肌层边界模糊、回声增强等表现。分娩时均再次选择剖宫产方式,手术过程中共6例发生子宫先兆破裂。3组产妇妊娠35周后的子宫下段肌层厚度均明显薄于妊娠20~25周时的肌层厚度;对照Ⅰ组和对照Ⅱ组孕20~25周及孕35周后的子宫下段肌层厚度均厚于观察组。在超声检查中,观察组6例出现肌层消失征兆。结论在超声下观察剖宫产后再次妊娠产妇的子宫下段特征能够提早发现潜在的影响分娩的风险因素,为产妇选择分娩方式提供依据,有助于保障母婴安全。
Objective To observe the ultrasound imaging features and clinical value of uterine segment of pregnant women with cesarean section. Methods A total of 800 pregnant women who underwent ultrasonography in the First People’s Hospital of Chengdu from October 2012 to June 2014 were selected. 400 cases with history of cesarean section (both in the lower uterine segment transverse incision cesarean section) as the observation group, 200 cases of postpartum pregnancy again pregnant women as control group Ⅰ, 200 cases of primipara as control group Ⅱ . Three groups of maternal ultrasonography were observed under the characteristics of the lower uterine segment, and measuring the thickness of the lower uterine muscle layer. Results In the observation group, the location of the scar in the maternal women during the ultrasonography showed that the local myoelasticity of the hypoechoic muscle was significantly thinner, the muscular layer was blurred and the echogenicity was enhanced. Cesarean section were selected again during childbirth, a total of 6 cases of uterine rupture occurred during the operation. The thickness of myometrium in the lower uterine segment was significantly thinner than that of the control group at 35 weeks after gestation. The thickness of myometrium at 20 ~ 25 weeks of gestation in control group Ⅰ and control group Ⅱ was significantly lower than that at 20 ~ 25 weeks and 35 weeks after gestation Thickness is thicker than the observation group. In the ultrasound examination, the observation group 6 cases of signs of myometrial disappeared. Conclusions Observing the characteristics of the lower uterine segment of the pregnant women after cesarean section under ultrasound can find out the potential risk factors of delivery before delivery and provide the basis for selecting the mode of delivery for the pregnant women and help to ensure the safety of mother and infant.