剖宫产后再次妊娠时机的安全性探讨

目的：从病理角度探讨剖宫产后妊娠的时机,分析疤痕子宫再次妊娠的安全性。方法：选取2012年3月1日至6月30日在我院行腹壁疤痕剔除＋子宫下段剖宫产术的156例剖宫产术后晚期妊娠孕妇,术中观察盆腹腔粘连情况,准确测量子宫下段厚度。取出胎盘后,取下段切口边缘最薄处的子宫肌壁组织送病理,检查其组织成分,并在高倍镜下测算子宫下段平滑肌与胶原纤维的比例（平胶比例）并行血管计数。选取同期行选择性剖宫产的30例初产妇为对照。通过临床观察,探讨疤痕子宫不同间隔时间再次妊娠临产前及临产后对母儿安全的影响。结果：剖宫产术后7-11个月、1-2年、2-3年、3-4年、4-5年、5-6年妊娠者,子宫下段厚度分别为（0.56±0.28）cm、（0.55±0.27）cm、（0.62±0.26）cm、（0.56±0.26）cm、（0.66±0.25）cm和（0.66±0.25）cm;平胶比例分别为2.98±0.97、2.83±1.54、2.49±0.93、2.26±0.94、2.47±1.14、2.81±0.98）;血管计数分别为（18.43±8.24、19.45±4.61、18.07±4.55、20.31±6.01、20.44±6.10、18.14±4.06）,以上6组比较,均无显著差异（P〉0.05）。剖宫产术后8年以上（8-11年）妊娠者,子宫下段厚度明显变薄,平胶比例降低,血管计数减少;与术后1-6年妊娠者及初次剖宫产者比较差异显著（P〈0.01）。术后1-6年妊娠者的子宫下段厚度与对照组无显著差异（P〉0.05）,平胶比例低于对照组,血管计数高于对照组,均有显著差异（P〈0.05）。结论：剖宫产术1年后开始妊娠是较安全的;术后8年尤其是10年以上妊娠者,子宫破裂风险明显增加,应密切观察子宫收缩情况及时予以适当的产科处理。

The safety of pregnant opportunity after cesarean section

Objective：To explore next pregnant opportunity after cesarean section and analyze the safety of uterine scar pregnancy. Methods： 156 patients with trimester of pregnancy who accepted cesarean section were collected from recent 4 month in our hospital. They accept-ed repeat cesarean section and abdominal wall scar removed if they want to operation. The ab-dominal condition was observed and the lower uterine segment thickness was measured accu-rately while operation. The thinnest uterine muscle wall tissue at the edge of incision was re-moved for pathology to check the composition of blood vessel count in high-powered microscope and uterine segment proportion of smooth muscle and collagen fibers was estimated after the pla- centa were taken. 30 primipara with elective cesarean section were as controls. The impact on the safety of mother and infant when pregnancy again after cesarean section at different intervals before and after labor were determined by clinical observation. Results：The lower uterine seg-ment thickness （0.56±0.28） cm, （0.55±0.27） cm ,（0.62±0.26 ） cm, （0.56±0.26） era, （0. 66±0.25） cm and （0.66±0.25） cm] ,proportion of smooth muscle and collagen fibers （2.98±0.97,2.83±1.54,2.49±0.93,2.26±0.94,2.47±1. 14,2.81±0.98） ,blood vessels count （ 18.43 -8.24,19.45±4.61,18.07±4.55,20.31±6.01,20.44±6.10,18.14±4.06） were not significantly different after cesarean section 1 year to 6 years of pregnancy（P〉0.05 ）. The lower uterine segment thickness（0.26±0.12,0.23 ±0.15,0.2±0.1 ） was significantly thinner,pro-portion of smooth muscle and collagen fibers（ 1.08±0.53,1.04±0.56,0.50±0.06 ） was low-er,blood vessels count（ 13.71 ±_3.99,10.43 ± 1.81,8.33 ± 1.53 ） was lower of the pregnant women more than 8 years after cesarean section compared to the pregnant women after cesarean section 1 year to 6 years（0.61±0.05,2.57±0.24,19.28±1.14） and women in control group （0.65±0.27,3.09±1.85,15.70±4.55） （P〈0.05）. The lower uterine segment thickness of women with cesarean section after 1 to 6 year was not different compared to women in control group. Proportion of smooth muscle and collagen fibers was lower, blood vessels count was high-er than women in control group（ P〈0.05 ）. Conclusion： It is feasible for patient to pregnancy who had uterus scar 1 year after previous operation. The risk of uterine rupture is increased after cesarean section 8 years especially 10 years. But it is imperatively to watch closely the uterine contraction, and to provide appropriate obstetric management in a timely manner.