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目的:探讨剖宫产术后再次妊娠分娩的处理方式。方法:B超测量122例前次剖宫产再次足月妊娠分娩患者子宫前壁下段瘢痕处厚度(试验组),另外选择150例同期在西安市中心医院足月妊娠分娩初产妇并测量其子宫前壁下段肌壁厚度(对照组),比较两组患者试产成功率、剖宫产率、并推断前次剖宫产再次妊娠分娩子宫下段瘢痕处厚度0.35 cm能否作为预测子宫瘢痕情况的指标。结果:试验组产妇子宫前壁下段瘢痕处厚度平均0.36 cm;对照组初产妇足月妊娠子宫前壁下段肌壁厚度平均0.50 cm,有统计学差异(P<0.01),试验组产妇38例试产,试产率31.0%,30例成功阴道分娩,试产成功率78.9%,总体剖宫产率75.0%。对照组产妇124例试产,试产率82.6%,107例成功分娩,试产成功率86.0%,总体剖宫产率28.6%。两组相比试产率、剖宫产率均有统计学差异(P<0.05),试产成功率无统计学差异(P>0.05)。结论:对于子宫下段横切口剖宫产术后再次妊娠分娩的产妇,临产前B超测定瘢痕部位厚度是一种有效预测瘢痕部位愈合情况的方法;瘢痕部位厚度≥0.35 cm是比较安全的;阴道试产的子宫前壁下段瘢痕处厚度的阈值,还需要进一步探讨。
Objective: To investigate the treatment of pregnancy and childbirth again after cesarean section. Methods: B-ultrasonography was used to measure the thickness of the scar in the lower anterior wall of the anterior uterine wall of 122 cases of previous cesarean section (test group). Another 150 cases of full-term first trimester maternal labor in Xi’an Central Hospital were selected and the uterus The thickness of the inferior wall of the anterior wall (control group) was compared between the two groups in terms of success rate of trial production and cesarean section, and whether the thickness of 0.35 cm at the lower uterine segment of the second cesarean section after pregnancy was estimated as the predictive value of uterine scar index. Results: In the experimental group, the average thickness of the anterior wall of the anterior uterus in the test group was 0.36 cm. The average thickness of the anterior wall of the anterior wall in the control group was 0.50 cm (P <0.01) The yield and trial yield were 31.0% and 30 cases were successful vaginal delivery. The success rate of trial production was 78.9%, and the overall cesarean section rate was 75.0%. The control group 124 cases of trial production, trial yield 82.6%, 107 cases of successful delivery, trial success rate of 86.0%, the overall cesarean section rate of 28.6%. There was a significant difference in test-yield and cesarean section rate between the two groups (P <0.05). There was no significant difference in trial-trial success rate (P> 0.05). Conclusions: The thickness of scar site measured by prenatal B ultrasound is an effective method for predicting the healing of scar site. The thickness of scar site ≥0.35 cm is more safe. For the vagina Trial production of uterine anterior wall thickness of the lower threshold of the scar needs further study.