| 摘要: |
| 目的 应用高频超声检查妊娠晚期子宫下段瘢痕,为妊娠分娩方式的选择提供参考。方法 118例剖宫产后再次妊娠患者,在妊娠36～40周,经腹超声检查胎儿后,换用频率7.5～12 MHz的高频探头,观察子宫下段瘢痕的高频超声表现特征,并与再次剖宫产时术中子宫下段不全破裂及瘢痕愈合不良等情况进行分析比较。结果 妊娠晚期子宫下段瘢痕的高频超声表现特征分为“截断状” (6.8%,8/118)、“鼠尾状” (44.1%,52/118)、“均匀一致” (49.1%,58/118)3种类型。“截断状”型诊断不全破裂、“鼠尾状” 型诊断瘢痕愈合不良、“均匀一致”型诊断瘢痕愈合正常的符合率均分别高于其他两型(χ2值分别为20.42、19.03、33.08,P均＜0.001)。以“截断状”型诊断不全破裂、“鼠尾状”型诊断瘢痕愈合不良、“均匀一致”型诊断瘢痕愈合正常的敏感性、特异性、阳性预测值、阴性预测值分别为80.0%、96.5%、50%、99.0%,70.0%、73.8%、67.3%、76.2%,72.9%、74.6%、74.1%、73.3%。 结论 高频超声能显示妊娠晚期子宫下段瘢痕的变化,是判断子宫下段不全破裂、瘢痕愈合不良、瘢痕愈合正常的有效方法。为避免子宫破裂的发生,高频超声显示为“截断状”和“鼠尾状”的患者,应慎重选择阴道试产。 |
| 关键词: 超声检查 子宫下段 瘢痕子宫再次妊娠 子宫破裂 瘢痕愈合不良 |
| DOI： |
| 投稿时间：2013-04-03修订日期：2013-05-28 |
| 基金项目:南通市社会事业科技创新与示范项目(HS2011033). |
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| High frequency ultrasound scan of lower uterine segment during the third trimester of scar uterus pregnancy: imaging features and implications |
| ZHANG Zhong-xin1,HUANG Hai-ming1,ZHENG Yan-li2,WU Ai-min2,XU Hai-yan1 |
(1. Department of Ultrasonography, the First People’s Hospital of Nantong, Nantong 226001, Jiangsu, China
2. Department of Obstetrics and Gynecology, the First People’s Hospital of Nantong, Nantong 226001, Jiangsu, China
*Corresponding author.) |
| Abstract: |
| Objective To use high frequency ultrasound for scanning the lower uterine segment during the third trimester of scar uterus pregnancy, so as to provide reference for selecting the way of delivery. Methods Totally 118 scar uterus pregnancy cases were selected. Transabdominal ultrasound scan was done for the fetus between 36th and 40th week of pregnancy, and then the transducer was switched to a high frequency of 7.5-12 MHz to observe the lower uterine segment. The scan results were compared with the observations of incomplete rupture of lower uterine segment and defective scars in the repeated caesarean section. Results Three types of high frequency ultrasound images were found for the lower uterine segment during the third trimester of scar uterus pregnancy: truncation sign (6.8%,8/118), rat tail sign (44.1%,52/118), and homogeneous echoes (49.1%,58/118). The diagnosis efficacies of truncation sign for incomplete rupture of uterus, rat tail sign for defective scars, and homogeneous echoes for intact caesarean scars were significantly higher than those of the other two types (χ2 valued 20.42, 19.03, and 33.08, respectively, P＜0.001). The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of the truncation sign were 80.0%, 96.5%, 50.0%, and 99.0%; those of the rat tail sign were 70.0%, 73.8%, 67.3%, and 76.2%; and those of homogeneous echoes were 72.9%, 74.6%, 74.1%, and 73.3%, respectively. Conclusion High frequency ultrasound scan can display the changes of the scars on the lower uterine segment, and may serve as an effective method to diagnose incomplete rupture of uterus, defective and intact scars in the third trimester pregnancy of a caesarean-scarred uterus. To avoid uterine rupture, vaginal trial of labor should be carefully chosen for patients showing truncation sign or rat tail sign. |
| Key words: ultrasonography lower uterine segment pregnancy with scarred uterus uterine rupture defective scars |
