剖宫产后再次妊娠中晚孕期超声观察子宫下段的研究

发布时间：2018-04-28 11:04

  本文选题：超声 + 疤痕子宫　； 参考：《浙江大学》2014年硕士论文

【摘要】：目的： 本研究旨在通过对剖宫产术后再次妊娠的病例,在中晚孕期进行经腹部及经会阴超声扫查,观察子宫下段的厚度、连续性等情况,分析其超声图像特征,评估不同超声扫查方式对观察子宫下段的价值、各自优势,超声测量子宫肌层厚度的可行性,为评价剖宫产术后再次妊娠病例的子宫疤痕情况提供影像学依据。 材料与方法： 选择剖宫产术后再次妊娠的249例孕妇作为研究组,77例未产妊娠孕妇为未产对照组,另39例经阴道分娩后再次妊娠孕妇作为经产对照组。所有受检者均在适度充盈膀胱后接受经腹部及经会阴超声检查。观察内容包括：尽可能大范围地扫查子宫前壁肌层情况,并对同范围的肌层进行彩色血流显示扫查,尝试确定前次剖宫产疤痕位置,并在最薄处测量肌肉层厚度,测量3次以上取最小值,记录观察及测量结果,对各组不同孕周得结果以及各组间的结果进行比较分析。对于研究组还进行了产时情况的随访记录,与产前超声检查及测量情况进行比较分析。 结果： 1.超声扫查可以获得较理想的声像图,能显示子宫前壁下段的三层结构(从内到外)：羊膜、绒毛膜与子宫壁之间的强回声层,子宫肌层的低回声层,子宫与膀胱壁分界强回声层。 2.总计509次检查中444次(87.2%)经腹扫查时获得的图像较经会阴扫查更理想。比较经腹部及经会阴测量结果均较理想的196例测量结果,两种测量结果相关性良好(r=0.943),经阴道测量结果大于经腹(p=0.000)。 3.对于研究组病例,43次检查(11.7%)能大致辨认疤痕位置,表现为局部肌层明显较周边薄、各层结构边界不清或回声增强增厚等情况,余324次检查未能辨认疤痕位置,仅能在尽可能大范围扫查后测量最薄处肌层厚度。 4.随着孕周的增大,剖宫产组、初产妇组和经产妇组的子宫下段肌层都逐渐变薄。 5.比较各组病例的子宫下段肌层厚度平均值,相同孕周病例,剖宫产组的子宫下段肌层最薄,其次是初产妇组,而经产妇组的子宫下段肌层最厚,组间差异有统计学意义。 6.研究组病例均以再次剖宫产的方式结束妊娠,术中见子宫下段无明显薄弱部分144例,局部较薄但未能透过子宫下段看到宫腔内容物87例,子宫先兆破裂即无明显肌层但浆膜层完整,可透过子宫下段看到宫腔内容物5例,术后诊断子宫破裂病例0例。 7.总计509次检查中CDFI血流显像有明显血流信号136次(26.7%)。 结论： 1.应用超声扫查的方式观察子宫下段前壁肌层的情况是可行的,在孕母充盈膀胱后经腹扫查可以获得较满意声像图,但仍有小部分病例必须结合经会阴扫查。 2.随着孕周增大,子宫下段厚度逐渐变薄。相同孕周病例,剖宫产组的子宫下段肌层最薄,其次是初产妇组,而经产妇组的子宫下段肌层最厚。 3.超声测量的子宫下段肌层厚度与再次剖宫产术中所见的子宫下段肌层厚度符合率高。选取1mm作为诊断阈值,提示子宫下段肌层缺陷,警惕子宫发生破裂的可能。 4.超声扫查及超声对子宫下段的测量可以客观的反应子宫下段的情况,但因课题内容所限不能得出子宫下段超声表现正常则预测阴道试产的安全性的结论。
[Abstract]:Objective:
The purpose of this study was to observe the thickness and continuity of the lower uterine segment in the middle and late pregnancy by scanning the abdominal and transperineal ultrasound in the middle and late pregnancy, and to evaluate the value of different ultrasonic scanning methods on the observation of the subsection of the uterus, the advantages of ultrasound and the ultrasonic measurement of the thickness of the uterine myometrium. It is feasible to provide imaging evidence for the evaluation of uterine scar after cesarean section.
Materials and methods:
249 pregnant women who were pregnant after cesarean section were selected as the study group, and 77 cases of non pregnancy pregnant women were not produced in the control group. The other 39 cases of the second pregnancy after vaginal delivery were used as the control group. All the subjects received the abdominal and transperineal ultrasound examination after the proper filling of the bladder. The contents included as large scope as possible. The situation of the myometrium of the anterior wall of the uterus was examined and the color flow of the myometrium in the same range was scanned. The position of the scar in the anterior cesarean section was determined and the thickness of the muscle layer was measured at the thinnest place. The minimum value was measured over 3 times. The results of observation and measurement were recorded and the results of each group were compared and analyzed. The group also conducted a follow-up record of birth time, and compared with prenatal ultrasound examination and measurement.
Result锛，

本文编号：1815002