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目的:通过B超监测评价剖宫产再孕的孕妇在整个妊娠过程中剖宫产瘢痕处的形态改变,并评价最后的分娩结局。方法:应用阴道超声观察320例有剖宫产史并再次妊娠的妇女怀孕11～13周、19～21周以及32～34周时剖宫产瘢痕的变化,主要测量剖宫产瘢痕处子宫肌层的厚度变化。结果:在320例孕妇中,284例发现剖宫产瘢痕的宽度、长度及厚度均发生改变,比例达到88.7%,瘢痕的长度和宽度明显增大,瘢痕的厚度明显变薄。2例孕妇因剖宫产瘢痕处子宫肌层发生破裂而终止妊娠,这2例病例,B超监测瘢痕处子宫肌层厚度为0.5mm,整个孕期减少了2.7mm、2.5mm。结论:通过观察,建立了相关的B超参考数据,并证明了剖宫产瘢痕在下一次妊娠中会发生形态学上的改变。菲薄的瘢痕处肌层厚度以及该处厚度的快速减少是剖宫产瘢痕破裂的先兆,在剖宫产再孕产妇的孕期监测过程中,瘢痕处肌层厚度的快速改变是提示剖宫产瘢痕破裂的潜在预警信号。这对防止剖宫产再孕的孕妇发生子宫破裂具有重要的意义。
OBJECTIVE: To evaluate the morphological changes of cesarean section scar during the whole pregnancy by B-monitoring and to evaluate the final delivery outcome. Methods: The changes of scar of cesarean section in 320 women with cesarean section and re-pregnancy at 11-11 weeks, 19-21 weeks and 32-34 weeks were observed by vaginal ultrasonography. The main measurement of uterine muscle at cesarean scar Layer thickness changes. Results: In 320 pregnant women, 284 cases of cesarean section scar width, length and thickness were changed, the proportion reached 88.7%, the length and width of scar significantly increased, the thickness of scar significantly thinned. 2 cases of pregnant women due to cesarean scar myometrial rupture and termination of pregnancy, the 2 cases, B-monitoring scar myometrial thickness of 0.5mm, the entire pregnancy decreased by 2.7mm, 2.5mm. CONCLUSIONS: By observing and establishing B-related reference data, it was demonstrated that morphological changes in cesarean scar may occur in the next pregnancy. The thickness of the muscular layer in the meager scar and the rapid decrease of the thickness there are a harbinger of cesarean scar rupture. During the pregnancy monitoring of cesarean section re-pregnant women, the rapid change of the muscular layer thickness in the scar is a sign of cesarean scar Potential warning signs of rupture. This is of great importance in preventing uterine rupture in pregnant women who have cesarean pregnancy.