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目的:探讨高频超声在剖宫产后瘢痕子宫再次妊娠分娩方式选择中的意义。方法:选取2011年5月~2013年5月间该院收治的有剖宫产史的再次妊娠孕妇136例,使用高频超声对其子宫下段结构和厚度进行观察,其中下段厚度<3 mm62例,≥3 mm 74例。厚度≥3 mm的74例孕妇中有37例选择进行阴道试产,厚度<3 mm的孕妇均行再次剖宫产,分析其术中超声情况和瘢痕愈合不良情况发生率。结果:有剖宫产史的孕妇妊娠晚期子宫下段瘢痕厚度明显小于无子宫手术史的孕妇,差异有统计学意义(P<0.05)。子宫下段厚度≥3 cm且超声显示瘢痕均匀一致的孕妇阴道试产成功率为75.68%。妊娠晚期子宫下段厚度<3 mm且超声表现为鼠尾状和截断状的孕妇中子宫不完全破裂和瘢痕愈合不良的发生率均明显高于超声表现为均匀一致型的孕妇,差异有统计学意义(P<0.01)。结论:高频超声检查可为是否行阴道试产提供重要参考依据,指导正确的分娩方式,避免盲目再次行剖宫产。
Objective: To investigate the significance of high frequency ultrasound in the selection of the mode of delivery after cesarean scar pregnancy. Methods: From May 2011 to May 2013 in our hospital, 136 pregnant women with recurrent pregnancy who had cesarean section were selected. The structure and thickness of the lower uterine segment were observed with high frequency ultrasound. The thickness of the lower segment was less than 3 mm in 62 cases , ≥ 3 mm 74 cases. Thirty-seven of 74 pregnant women with a thickness of ≥3 mm were selected for vaginal trial. Cesarean section was performed in pregnant women <3 mm in thickness. The intraoperative ultrasound and the incidence of scar healing were analyzed. Results: The pregnant women with a history of cesarean section had significantly lower scar thickness in the third trimester of pregnancy than those without uterine surgery (P <0.05). The lower uterine thickness ≥ 3 cm and ultrasound showed uniform scar pregnancy rate of successful vaginal delivery test was 75.68%. The incidence of incomplete rupture of uterus and scar healing in the second trimester of pregnancy when the thickness of the lower uterus <3 mm and the sonographic appearance of the tail and the truncated uterus were significantly higher than those of the pregnant women with uniform uterine ultrasound, the difference was statistically significant (P <0.01). Conclusion: High-frequency ultrasound can provide an important reference for whether vaginal trial production or not, to guide the correct mode of delivery, to avoid blind re-cesarean section.