瘢痕子宫再次妊娠孕妇阴道试产结局与子宫前壁下段肌层厚度的关系
| 作者: |
1唐蓉,
1余琦,
1李小清,
1吴文萃
1 海口市妇幼保健院超声医学科，海口 570203 |
| 通讯: |
唐蓉
Email: 18308337@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2022.05.013 |
摘要
目的：探讨瘢痕子宫再次妊娠孕妇阴道试产结局和子宫前壁下段肌层厚度的关系。方法：选取2019年2月至2021年3月海口市妇幼保健院收治的120例具备阴道试产指征的瘢痕子宫再次妊娠孕妇，均同意阴道试产和接受子宫前壁下段肌层厚度超声测量。依据阴道试产结局分为成功组和失败组，比较两组孕妇子宫前壁下段肌层厚度和围产期相关指标。比较不同超声分级子宫前壁下段肌层厚度孕妇的阴道试产结局。绘制受试者工作特征(receiver operating characteristic，ROC)曲线分析子宫前壁下段肌层厚度对阴道试产结局的预测价值。结果：阴道试产成功率为62.50%(75/120)。超声测量显示：子宫前壁下段肌层厚度I级(>3 mm)79例，II级(2~3 mm)41例。成功组子宫前壁下段肌层厚度高于失败组(P<0.01)。I级孕妇的阴道试产成功率高于II级，先兆子宫破裂发生率低于II级，差异均有统计学意义(均P<0.05)。ROC曲线分析显示：子宫前壁下段肌层厚度预测阴道试产成功的曲线下面积(area under the curve，AUC)为0.703，最佳截断值为3.87 mm，敏感度为63.86%，特异度为78.38%。结论：瘢痕子宫再次妊娠孕妇的子宫前壁下段肌层厚度的超声测量值与阴道试产成功率、先兆子宫破裂发生风险紧密相关，对临床预测阴道试产结局有一定参考价值。
关键词：
瘢痕子宫；妊娠；阴道试产；子宫前壁下段肌层厚度；预测
Relationship between vaginal trial delivery outcome and myometrial thickness of lower anterior wall of uterus in pregnant women with second pregnancy of scarred uterus
CorrespondingAuthor: TANG Rong Email: 18308337@qq.com
DOI: 10.3978/j.issn.2095-6959.2022.05.013
Abstract
Objective: To investigate the relationship between the outcome of vaginal trial delivery and the thickness of the lower segment of the anterior wall of the uterus in pregnant women. Methods: A total of 120 pregnant women with scarred uterus with indications of vaginal trial delivery treated in Haikou Maternal and Child Health Hospital from February 2019 to March 2021 were selected for this study. They agreed to have vaginal trial delivery and undergo ultrasonic measurement of the thickness of the lower segment of the anterior wall of the uterus. According to the outcome of vaginal trial delivery, the pregnant women were divided into a successful group and a failure group. The thickness of myometrium in the lower part of anterior wall of uterus and perinatal related indexes was compared between the 2 groups. We compared the results of vaginal trial delivery of pregnant women with different ultrasonic grades of the thickness of the lower segment of the anterior wall of the uterus. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of the thickness of the lower segment of the anterior wall of the uterus on the outcome of vaginal trial delivery. Results: The success rate of vaginal trial delivery was 62.50% (75/120). Ultrasound measurement showed that the thickness of myometrium in the lower segment of anterior wall of uterus was grade I (>3 mm) in 79 cases and grade II (2–3 mm) in 41 cases. The thickness of the lower segment of the anterior wall of the uterus in the successful group was significantly higher than that in the failed group (P<0.01). The successful rate of vaginal trial delivery in grade I was higher than that in grade II, and the incidence of threatened uterine rupture was lower than that in grade II, with significant difference (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) for predicting the success of vaginal trial delivery was 0.703, the best cut-off value was 3.87 mm, the sensitivity was 63.86%, and the specificity was 78.38%. Conclusion: The ultrasonic measurement for the thickness of the lower segment of the anterior wall of the uterus is closely related to the successful rate of vaginal trial delivery and the risk of threatened uterine rupture, which has a reference value for clinical prediction of the outcome of vaginal trial delivery.
Keywords：
scar uterus; pregnancy; vaginal trial; thickness of myometrium in the lower segment of anterior wall of uterus; prediction