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目的探讨瘢痕子宫再次妊娠患者子宫下段肌壁厚度随分娩间隔时间变化的趋势,分析两者对阴道试产结局的影响。方法对2010年1月—2017年1月合肥市第一人民医院接受阴道试产的134例瘢痕子宫孕妇进行回顾性分析其临床资料。结果 134例患者中,87例试产成功。试产成功组分娩间隔时间长于试产失败组(P<0.001),子宫下段肌壁厚于试产失败组(P<0.01)。子宫下段肌壁厚度与分娩间隔时间呈轻度负相关(r=-0.287,P=0.001)。参考loess拟合曲线,将患者划分为A组(间隔时间≤72月,82例)、B组(间隔时间>72月,52例),B组试产成功率明显高于A组(P<0.05)。A组子宫下段肌壁厚度与分娩间隔时间无关(P>0.05),其中试产成功43例,其子宫下段肌壁厚于试产失败者(P<0.01),ROC曲线显示A组子宫下段肌壁厚度对试产结果有一定预测作用(曲线下面积0.699);B组子宫下段肌壁厚度与分娩时间间隔呈负相关(r=-0.503,P<0.001),其中试产成功44例,其子宫下段肌壁厚度与试产失败者接近(P>0.05)。先兆子宫破裂共4例,分娩间隔时间均<36月,子宫下段肌壁厚度均>4 mm。结论瘢痕子宫再次妊娠且满足阴道试产指征患者,其子宫下段肌壁厚度随时间变化呈先稳定后下降趋势;处于下降趋势阶段,患者阴道试产成功率高于稳定阶段患者;处于稳定趋势阶段,患者子宫下段肌壁厚度越高,其阴道试产成功率更高。
Objective To investigate the trend of changes in the muscle wall thickness of the uterine segment of uterine cervix during the second trimester pregnancy with interval of delivery and to analyze the effect of the two on vaginal trial production. Methods The clinical data of 134 cases of uterine scar from January 2010 to January 2017 in HeBei First People ’s Hospital who underwent vaginal trial were retrospectively analyzed. Results Of the 134 patients, 87 trials were successful. The success of trial production was longer than that of failed trial (P <0.001), and the lower wall of uterine muscle was thicker than that of trial failed (P <0.01). The wall thickness of the lower uterine segment was slightly negatively correlated with the interval of delivery (r = -0.287, P = 0.001). The patients were divided into group A (n = 82, interval 72 months) and group B (interval 72 months, n = 52). The success rate of trial production in group B was significantly higher than that of group A (P < 0.05). A group of lower uterine muscle wall thickness and childbirth interval time was not related (P> 0.05), of which 43 cases of successful trial production, the lower wall of the uterine muscle thicker than the failure of trial production (P <0.01), ROC curve showed lower uterine muscle group A The thickness of the wall had a certain predictive value on the trial production (area under the curve 0.699). The thickness of the muscle wall of the lower uterine segment in group B was negatively correlated with the interval of delivery (r = -0.503, P <0.001) The lower uterine muscle wall thickness and pilot production losers were close (P> 0.05). A total of 4 cases of threatened uterine rupture, childbirth interval of <36 months, lower uterine muscle wall thickness> 4 mm. Conclusions Patients with scar uterine pregnancy who meet the indications for vaginal trial also showed that the thickness of the muscle wall of the lower uterine segment first stabilized and then decreased. In the downward trend phase, the success rate of vaginal trial was higher than that in the stable stage. Stage, the higher the thickness of the lower uterine muscle wall, the higher success rate of vaginal trial production.