剖宫产瘢痕憩室再生育分娩方式及妊娠结局分析
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摘要
目的:探讨剖宫产瘢痕憩室(CSD)再生育分娩方式及妊娠结局。方法:收集剖宫产术后再次妊娠孕妇资料,根据瘢痕愈合情况分为CSD组(298例)及非CSD组(443例),比较两组孕妇子宫下段肌层厚度、分娩方式及妊娠结局。结果:孕妇子宫下段厚度及经阴试产、经阴分娩比率非CSD组高于CSD组,紧急剖宫产比率CSD组(25.6%)高于非CSD组(20.8%)(均P<0.05),经阴试产成功率两组无差异(P>0.05);紧急剖宫产指征前4位比较,两组胎儿窘迫、前置胎盘产前出血及宫内感染所占比率无差异(P>0.05),先兆子宫破裂比率CSD组(7.9%)高于非CSD组(1.2%)(P<0.05);两组孕妇剖宫产术中子宫下段肌层Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级构成比有差异,子宫下段肌层异常发生率CSD组(24.0%)高于非CSD组(17.4%)(P<0.05);宫缩乏力比率CSD组(6.2%)高于非CSD组(3.4%)(P<0.05),分娩孕周、前置胎盘、产后出血、新生儿出生体重及新生儿窒息发生情况无差异(P>0.05)。结论:与瘢痕愈合良好的孕妇比较,CSD再次妊娠子宫下段肌层厚度较薄者发生先兆子宫破裂风险较高,再次剖宫产比率增加,术中子宫下段异常比率较高,更易发生宫缩乏力。
Objective: To explore the delivery mode and pregnancy outcomes of pregnant women with cesarean scar diverticulum(CSD). Methods: The pregnant women with history cesarean section were selected and divided into CSD group and non-CSD group according to the situation of scar healing. The muscle layer thickness of uterus low segment, delivery method, and pregnancy outcomes of women were compared between the two groups. Results: The muscle layer thickness of uterus low segment and the ratio of vaginal delivery of women in non-CSD group were significant higher than those of women in CSD group(P<0.05), but the emergency cesarean section rate(20.8%) was statistical lower than that(25.6%) of women in CSD group(P<0.05). There were no significant different in the rates of fetal distress, volume of antepartum haemorrhage because of placenta previa, and rate of intrauterine infection between the two groups(P>0.05). The rate of threatened uterine rupture distribution of women(1.2%) in CSD group was significant higher than that(7.9%) of women in non-CSD group(P<0.05). The proportion of Ⅰ, Ⅱ, Ⅲ, and Ⅳclass of women in non-CSD group was different from that of women in CSD group, and the rate of abnormal muscle layer thickness of uterus low segment of women(24.0%) in CSD group was significant higher than that(17.4%) of women in non-CSD group(P<0.05). The rate of uterine inertia of women(6.2%) in CSD group was significant higher than that(3.4%) of women in non-CSD group(P<0.05), but there were no significant different in gestational weeks when delivery, and rates of placenta previa and postpartum hemorrhage, birth weight, and rate of neonatal asphyxia between the two groups(P>0.05). Conclusion: Comparing with pregnant women with good scar healing, CSD pregnant women has higher risk of thin muscle layer of uterus low segment and threatened uterine rupture, and the rate of cesarean section again increases, a higher abnormal rate of lower uterine segment, and is more prone to uterine inertia.
Objective: To explore the delivery mode and pregnancy outcomes of pregnant women with cesarean scar diverticulum(CSD). Methods: The pregnant women with history cesarean section were selected and divided into CSD group and non-CSD group according to the situation of scar healing. The muscle layer thickness of uterus low segment, delivery method, and pregnancy outcomes of women were compared between the two groups. Results: The muscle layer thickness of uterus low segment and the ratio of vaginal delivery of women in non-CSD group were significant higher than those of women in CSD group(P<0.05), but the emergency cesarean section rate(20.8%) was statistical lower than that(25.6%) of women in CSD group(P<0.05). There were no significant different in the rates of fetal distress, volume of antepartum haemorrhage because of placenta previa, and rate of intrauterine infection between the two groups(P>0.05). The rate of threatened uterine rupture distribution of women(1.2%) in CSD group was significant higher than that(7.9%) of women in non-CSD group(P<0.05). The proportion of Ⅰ, Ⅱ, Ⅲ, and Ⅳclass of women in non-CSD group was different from that of women in CSD group, and the rate of abnormal muscle layer thickness of uterus low segment of women(24.0%) in CSD group was significant higher than that(17.4%) of women in non-CSD group(P<0.05). The rate of uterine inertia of women(6.2%) in CSD group was significant higher than that(3.4%) of women in non-CSD group(P<0.05), but there were no significant different in gestational weeks when delivery, and rates of placenta previa and postpartum hemorrhage, birth weight, and rate of neonatal asphyxia between the two groups(P>0.05). Conclusion: Comparing with pregnant women with good scar healing, CSD pregnant women has higher risk of thin muscle layer of uterus low segment and threatened uterine rupture, and the rate of cesarean section again increases, a higher abnormal rate of lower uterine segment, and is more prone to uterine inertia.
引文
[1] 于晓兰,韦晓昱.剖宫产瘢痕憩室[J].中国计划生育学杂志,2018,(1):5-8.
[2] Baranov A,Gunnarsson G,Salvesen KA,et al.Assessment of Cesarean hysterotomy scar in non-pregnant women:reliability of transvaginal sonography with and without contrast enhancement[J].Ultrasound Obstet Gynecol,2016,47(4):499-505.
[3] 赵一,冯力民.剖宫产瘢痕憩室的再生育问题[J].中国计划生育和妇产科,2017,9(6):4-6.
[4] Allornuvor GF,Xue M,Zhu X.The definition,aetiology,presentation,diagnosis and management of previous caesarean scar defects[J].J Obstet Gynaecol.2013,33(8):759-763.
[5] 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].中华妇产科杂志,2016,51(8):561-564.
[6] 洪燕语.剖宫产子宫瘢痕憩室患者再生育结局[D].杭州:浙江大学,2017.
[7] 魏燕,高金芳,钱桂兰,等.剖宫产术后子宫切口憩室的相关问题[J].中华围产医学杂志,2015,18(11):867-869.
[8] 张晓燕,韩晖.剖宫产瘢痕憩室再次妊娠结局的探讨[J].中国妇幼卫生杂志,2018(3):页码???.
[9] 张勤建,颜建英.剖宫产瘢痕子宫妊娠期管理[J].实用妇产科杂志,2018(1):3-6.
[10] 李玲,于昕,郎景和.剖宫产术后再次妊娠子宫破裂10例临床分析[J].中国实用妇科与产科杂志,2014,30(12):981-983.
[11] 王少丽,韩蓁,董晋,等.剖宫产术后子宫切口瘢痕缺陷手术治疗的疗效及再次妊娠情况分析[J].河北医学,2017(12):2040-2043.
[12] 周平,李柳娇,赖东娣,等.超声检测子宫下段瘢痕缺陷对瘢痕子宫再次妊娠分娩方式选择的临床价值[J].中国实用医药,2018(6):3-5.
[13] 杨慧霞,李博雅.剖宫产后时代面临的挑战剖宫产术后再次妊娠阴道分娩相关问题[J].中华妇产科杂志,2016,51(8):573-575.
[14] Kok N,Wiersma IC,Opmeer BC,et al.Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous cesarean section:a meta-analysis[J].Ultrasound Obstet Gynecol,2013,42(2):132-139.
[2] Baranov A,Gunnarsson G,Salvesen KA,et al.Assessment of Cesarean hysterotomy scar in non-pregnant women:reliability of transvaginal sonography with and without contrast enhancement[J].Ultrasound Obstet Gynecol,2016,47(4):499-505.
[3] 赵一,冯力民.剖宫产瘢痕憩室的再生育问题[J].中国计划生育和妇产科,2017,9(6):4-6.
[4] Allornuvor GF,Xue M,Zhu X.The definition,aetiology,presentation,diagnosis and management of previous caesarean scar defects[J].J Obstet Gynaecol.2013,33(8):759-763.
[5] 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].中华妇产科杂志,2016,51(8):561-564.
[6] 洪燕语.剖宫产子宫瘢痕憩室患者再生育结局[D].杭州:浙江大学,2017.
[7] 魏燕,高金芳,钱桂兰,等.剖宫产术后子宫切口憩室的相关问题[J].中华围产医学杂志,2015,18(11):867-869.
[8] 张晓燕,韩晖.剖宫产瘢痕憩室再次妊娠结局的探讨[J].中国妇幼卫生杂志,2018(3):页码???.
[9] 张勤建,颜建英.剖宫产瘢痕子宫妊娠期管理[J].实用妇产科杂志,2018(1):3-6.
[10] 李玲,于昕,郎景和.剖宫产术后再次妊娠子宫破裂10例临床分析[J].中国实用妇科与产科杂志,2014,30(12):981-983.
[11] 王少丽,韩蓁,董晋,等.剖宫产术后子宫切口瘢痕缺陷手术治疗的疗效及再次妊娠情况分析[J].河北医学,2017(12):2040-2043.
[12] 周平,李柳娇,赖东娣,等.超声检测子宫下段瘢痕缺陷对瘢痕子宫再次妊娠分娩方式选择的临床价值[J].中国实用医药,2018(6):3-5.
[13] 杨慧霞,李博雅.剖宫产后时代面临的挑战剖宫产术后再次妊娠阴道分娩相关问题[J].中华妇产科杂志,2016,51(8):573-575.
[14] Kok N,Wiersma IC,Opmeer BC,et al.Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous cesarean section:a meta-analysis[J].Ultrasound Obstet Gynecol,2013,42(2):132-139.