再次剖宫产子宫下段肌层断裂情况分析

Analysis of the disruption of the lower uterine segment muscle layer in repeat cesarean section

关键词:  再次剖宫产  子宫下段肌层断裂  间隔时间  B 超  新生儿体重

Key words:  repeat cesarean section  the disruption of the lower uterine segment muscle layer  the interval time  B scan  the birth weight

摘要:

目的　通过再次剖宫产子宫下段肌层断裂情况的临床分析，探讨剖宫产术后再次妊娠的最佳时间及其分娩方式的选择。　方法　回顾2008年1月—2011年12月139例再次剖宫产子宫下段肌层情况的资料，分析其与再次剖宫产间隔时间、临床症状体征、产程、B超检查结果及新生儿体重的关系。　结果　（1）两次剖宫产间隔时间在12～24个月间，子宫下段变薄及破裂的几率最大；24～36个月子宫下段变薄及破裂的几率最小（P<0.05）；36～48个月子宫下段变薄及破裂几率再次升高；48个月及以后子宫下段变薄几率增大，破裂几率略下降（P<0.05）。（2）再次剖宫产孕妇中有症状及体征者，子宫下段变薄及破裂的几率高；产程情况与子宫下段肌层断裂无关（P>0.05）， B超提示子宫下段厚度≤3 mm者42例，与术中发现子宫下段变薄及破裂的32例符合率为76.2%。（3）新生儿体重与瘢痕子宫下段肌层断裂无关（P>0.05）。　结论　剖宫产术后再次妊娠最佳时间为24个月左右；再次剖宫产孕妇下腹疼痛伴子宫下段不平及压痛，B超检查提示异常宜选择剖宫产。

Abstract:

Objective　Through the retrospective analysis to the disruption of the lower uterine segment muscle layer, discussing the best time of pregnancy and the mode of delivery after repeat cesarean section. 　Methods　 Comparing the interval time between the repeat cesarean section; clinical symptoms and signs; labor condition; B scan and birth weight with 139 cases repeat cesarean section of the lower uterine segment muscle layer from January 2008 to December 2011.　Results　(1)The rate of thinning and disruption is the highest from 12 to 24 months; From 24 to 36 months, the rate becomes the lowest（P<0.05）; From 36 to 48 months, the rate rises again; From 48 months and then, the rate of thinning is rising, the rate of disrupttion is slightly lower（P<0.05）.(2)Of the clinical symptoms and signs，the rate of thinning and disruption is higher; Labor condition has no relation to the disruption of the lower uterine segment muscle layer（P>0.05）;The rate is 76.2% in 42 cases the thickness ≤3 mm of the lower uterine segment throngh B scan coinciding with the thinning and disruption during the operation.(3)The birth weight is no relation to the disruption of the lower uterine segment muscle layer （P>0.05）.　Conclusion　The best pregnancy time is 24 to 36 months after repeat cesarean section . With the abdominal pain; the unevenness and tenderness in lower uterine segment; the unusual in B scan is a preference for repeat cesarean section.