摘要
目的评价B型超声在终止瘢痕子宫中期妊娠的指导价值。方法64例剖宫产术后再次妊娠达孕16—27周要求终止妊娠妇女，通过B型超声检测子宫瘢痕厚度结合患者意愿以决定终止妊娠方式，分为利凡诺引产45例和小型剖宫取胎手术19例，记录两种方法成功引产的结局和小剖宫术中所见，并与检测的子宫瘢痕厚度进行统计分析。结果64例剖宫产术后再次妊娠妇女引产率70．3％（45例），成功率为100％，无子宫破裂发生。子宫瘢痕厚度〉15mm患者49例，43例引产成功，6例要求手术，术中均见子宫切VI愈合良好；瘢痕厚度3～5mm患者11例，2例要求引产成功，9例手术，其中1例术中见先兆子宫破裂；瘢痕厚度≤3mm患者4例，均手术，3例术中见先兆子宫破裂。采用受试者工作特性曲线确定术前子宫瘢痕厚度≤3mm为预测有无先兆子宫破裂的最佳临界点，其灵敏度75％，特异度98．33％，阳性预测值75％，阴性预测值98．33％，准确度96．88％。结论通过B型超声检测剖宫产切口瘢痕厚度对临床决定瘢痕子宫中孕终止妊娠中方式有指导意义，且瘢痕厚度〉3mm利凡诺引产是安全可行的。
Objective To evaluate the value of ultrasound guidance of midtrimester pregnancy termination of scarred uterus. Methods Totally 64 cases of patients who wanted to terminate the pregnancy up to 16-27 weeks after cesarean section, were divided into 45 cases of rivanol induced abortion and 19 cases of small-scale surgery, through the B-test in patients with uterine scar thickness combine the patients＇ will to determine the mode of termina- tion of pregnancy. The outcome of labor induction by both methods and the observation during small-scale surgery were recorded. The uterus scar thickness was also analyzed. Results The rate of the rivanol induced abortion in the 64 cases pregnancy after cesarean section was 70.3% （45 cases）. The success rate was 100%. No uterine rup- ture occurred. 49 patients had uterus scar thickness over 5mm. 6 cases were given operation and in the operation it was found that all the uterus wound healed very well. 11 patients had uterus scar thickness of 3 - 5 ram. 2 cases had successful induced abortion by medicine. 9 cases took operation and the precursor of uterine rupture was observed in 1 of these 9 cases. 4 patients bad uterus scar thickness less than 3 ram. They all had operation and the precursor of uterine rupture was observed in 3 cases. Receiver operating characteristic curve found that the preoperative uterine scar thickness less than 3 mm was the critical point of predicting the precursor of uterine rupture. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 75%, 98.33%, 75%, 98. 33%, and 96.88%, respectively. Conclusions Measuring the cesarean section incision scar thickness with B- mode ultrasound helps make the decision to terminate midtrimester pregnancy of scarred uterus. The rivanol induced abortion is safe and feasible for patients with uterus scar thickness greater than 3 mm.
出处
《中国医药》
2010年第3期258-260,共3页
China Medicine
关键词
瘢痕子宫
中期妊娠
超声
Scarred uterus
Midtrimester pregnancy
Ultrasound
