超声波诊断妊娠子宫瘢痕缺限

应用Ｂ超对７１例初产妇（妇产妇组）和３１例有剖宫产史的孕妇（剖宫产史组），自妊娠３３～４１周连续进行子宫下段形成状况及子 宫下段瘢痕缺陷的观察。结果：１０２例孕妇的子宫下段在妊娠３３周以后均已形成；妊娠３７周以后，剖宫产史经组较同期初产妇组庸露蔚某ぁ⒖怼⒑窬毒醵獭Ｆ使纷橹校防鲁锒洗嬖谧庸露务：廴毕荩渲校怖锒衔日鬃庸屏眩⒕质踔な怠Ｌ崾荆河τ茫鲁山腥焉锲谧庸露伪浠     

应用B超筛查妊娠晚期子宫瘢痕缺陷初探

目的 探讨应用B超筛查妊娠晚期子宫瘢痕缺陷，预测瘢痕子宫破裂的可行性。方法 应用B超对有剖宫产史的孕妇，自妊娠33～41周连续进行子宫下段厚度及子宫下段瘢痕缺陷的观察。结果 396例孕妇的子宫下段在妊娠33周以后均已形成，69例经B超诊断存在子宫下段瘢痕缺陷，其中9例诊断为先兆子宫破裂，并均经手术证实。结论 应用B超可进行妊娠期子宫下段变化的动态观察，并预测先兆子宫破裂。     

瘢痕子宫再次妊娠阴道分娩的临床探讨

瘢痕子宫是指剖宫产或肌间型肌瘤剥除后的子宫。瘢痕子宫再次分娩，若前次剖宫产绝对指征(如骨盆狭窄等)不存在时可考虑阴道试产及阴道自然分娩，并非均需再次剖宫产。通过对选择进行阴道试产成功(106例)与失败(23例)的瘢痕子宫妊娠的分析，希望对产科临床工作有所裨益。     

瘢痕子宫妊娠有关问题的探讨

对161例瘢前子宫妊娠的有关问题进行分析，其中经阴道分娩9．4％，前壁胎盘51％，粘连胎盘7．5％，前置胎盘5．7％，胎盘植入0．9％，后三者产后出血量显著增多，足月孕子宫破裂4．15，产褥病率6．6％，上述病理状态及术中可否见到子宫瘢痕与瘢痕形成距怀孕的时间无关，本组人工流产术和雷夫奴尔引产术未见严重并发症，认为提高第一次手术质量，给瘢痕子宫妊娠足月者予以阴道试产的机会，在警惕子宫破裂抽时，也要重视胎盘附着的异常。     

妊娠晚期瘢痕子宫隐性破裂六例分析

目的　探讨隐性子宫破裂发生的原因、诊断、预防及处理方法。　方法　回顾性分析1978年 1月至 1998年 12月 ,在我院剖宫产后再次妊娠住院的产妇 141例 ,共发现隐性子宫破裂 6例。结果　 6例产妇均经入院后检查、B超检查 ,并复习前次剖宫产病历及时作出了诊断而行剖宫产术 ,母婴无一死亡。　结论　前次剖宫产的术式与缝合技术、前次剖宫产术后切口愈合情况、宫壁的压力不均匀、妊娠晚期子宫自发性的收缩等均为子宫隐性破裂的诱因。提高剖宫产术中的手术技巧和缝合技术 ,预防感染可预防下次妊娠时子宫破裂 ,对于怀疑有子宫隐性破裂的产妇 ,应高度警惕。     

子宫瘢痕妊娠治疗进展

子宫瘢痕妊娠属于异位妊娠的一种特殊类型,是具有高度危险的妊娠并发症。剖宫产率的居高难下,导致其发病率呈明显增长趋势。近10余年来,该病的诊断尤其是治疗方面发展较为迅速,化疗药物、介入治疗、腔镜手术、经阴以及传统开腹手术等多种治疗的实践和比较,旨在规范治疗,减少损伤,降低该病对育龄妇女生育和生命健康的危害。     

剖宫产子宫瘢痕妊娠的诊断与治疗进展

剖宫产子宫瘢痕妊娠是指子宫下段剖宫产、子宫复旧后子宫峡部瘢痕处妊娠，是位于子宫体腔以外的异位妊娠。近年其发生率明显增加，可以引起子宫破裂、大出血等严重并发症。其临床表现、诊断与治疗均具有一定的特征性。因此，被视为一种特殊而严重的异位妊娠。阴道超声检查在其诊断中起重要作用，手术及药物治疗成为其主要的治疗手段。综述剖宫产子宫瘢痕妊娠的病因学、诊断与治疗进展。     

剖宫产后子宫瘢痕妊娠合并宫内妊娠的诊断及治疗

目的:通过回顾分析相关文献,总结剖宫产后子宫瘢痕妊娠合并宫内妊娠(HCSP)的临床表现、诊断、治疗及预后等,从而为临床诊疗提供参考。方法:检索PubMed、万方及中国期刊全文数据库中的HCSP相关文献。通过阅读文献全文,总结分析HCSP的临床表现及诊断方法,并重点探讨其治疗方法及治疗方法与预后的关系。结果:共收集HCSP患者15例,其中自然妊娠6例,体外受精-胚胎移植(IVF-ET)9例。诊断时间为孕5周至8+4周,其中6例患者有阴道流血,其余均无特殊不适;患者均通过阴道超声得以确诊。1例患者因无生育要求而选择甲氨蝶呤直接终止妊娠;14例患者中,期待治疗、宫腔镜及腹腔镜手术治疗各1例,超声监测下原位减胎术[抽吸和(或)药物注射)]11例,患者均成功减胎并继续妊娠。1例因孕12周超声提示胎儿畸形而终止妊娠;13例通过剖宫产而获得活婴,其中3例为足月择期剖宫产,10例因急诊手术指证而行剖宫产终止妊娠,4例出现术中大出血需抢救治疗。结论:剖宫产术后的再次妊娠,尤其是通过辅助生殖技术而受孕者需考虑到HCSP的可能。阴道超声是HCSP诊断及治疗的重要工具。目前超声监测下原位减胎术是治疗HCSP的主要方法,并可获得成功的宫内继续妊娠,但继续妊娠者孕期及围产期并发症多,需严格按高危妊娠积极处理。     

高龄女性瘢痕子宫再妊娠

随着我国二孩政策的全面实施,以往因各种因素导致瘢痕子宫妊娠的高龄孕妇明显增多。鉴于高龄及各种病因导致的子宫瘢痕形成的特点不同,再次妊娠的时机、孕期监测及风险各有差异。文章仅就比较常见的瘢痕子宫再妊娠的上述相关问题进行讨论,希望为产科临床工作者提供参考。     

经阴道子宫瘢痕妊娠病灶切除术治疗子宫瘢痕妊娠的临床分析

目的:探讨经阴道子宫瘢痕部位妊娠病灶切除及子宫修补术治疗子宫瘢痕妊娠(CSP)的临床疗效。方法:回顾分析2012年1月至2014年1月我院收治的52例经阴道子宫瘢痕部位妊娠病灶切除及子宫修补术治疗CSP患者的临床资料。结果:除1例患者因子宫与前腹壁粘连紧密改开腹手术外,其余患者手术均顺利。平均手术时间39.8min,平均术中出血量85.2ml;术后血β-HCG水平下降率平均为86.8%;平均住院时间8.2天;平均住院费用9093.4元。结论:经阴道子宫瘢痕部位妊娠物清除及子宫修补术治疗CSP具有安全、有效、微创、经济的优点,值得临床推广。     

经阴道手术治疗剖宫产术后子宫瘢痕妊娠31例临床分析

目的 探讨经阴道手术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果.方法 对鞍山市妇儿医院妇产科2008年1月至2011年3月收治的符合CSP诊断标准的31例患者行经阴道手术治疗,根据其超声检查结果及术中暴露病灶情况,酌情选择不同术式,其中经阴道局部病灶清除术+子宫壁修补术(A组)l5例,经阴道结扎子宫动脉后行刮宫术(B组)7例,经阴道纵向切开宫颈前壁和子宫前壁下段于直视下清除病灶并行子宫修补术(C组)9例.比较各组术中出血量、手术时间、住院时间、术后血hCG恢复正常的时间及并发症发生情况.结果 3组患者均一次性手术成功.(1)术中出血量A组为(41±21) ml、B组为(27±7) ml、C组为(148±132)ml,A、B两组术中平均出血量比较,差异无统计学意义(P＞0.05),而C组术中平均出血量明显多于A、B两组(P＜0.05);(2)手术时间、住院时间、术后血hCG恢复正常时间A组分别为(40±11) min、(4.7±0.8)d和(2.7±1.0)周,B组分别为(44±5) min、(4.0±0.8)d和(2.9±1.0)周,C组分别为(40±12) min、(4.9±1.0)d和(2.8±0.9)周,3组间分别比较,差异均无统计学意义(P＞0.05);(3)3组无一例膀胱损伤等并发症发生.结论 经阴道手术治疗CSP,疗效确切、操作简单、可保留子宫、安全经济,其中A组术式适用于病灶为外生型的早期病例,B组术式适用于病灶为内生型的病例,C组术式适用于前两种术式操作困难或失败的病例,但损伤较前两种术式大.     

Transvaginal removal of ectopic pregnancy tissue and repair of uterine defect for caesarean scar pregnancy

From December 2009 to April 2010, six patients with caesarean scar pregnancies (CSPs) underwent the transvaginal removal of ectopic pregnancy tissue and repair of a uterine defect. Transvaginal surgery was performed uneventfully in all cases. The operating time ranged from 45 to 80 minutes. Blood loss ranged from 50 to 150 ml. Serum β-hCG (β-subunit of human chorionic gonadotrophin) levels declined to normal levels within a month for all patients, and all patients recovered without complications. Our results show that the transvaginal removal of ectopic pregnancy tissue and repair of the uterine defect is effective, safe, and minimally invasive for patients with CSP.     

Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect

Objective

Research suggests that the resectoscopic management of abnormal uterine bleeding (AUB) following cesarean section (CS) is safe and effective. There is, however, a lack of complementary data from routine clinical practice. We aimed to evaluate the efficacy of resectoscopic remodeling of the CS scar in the management of post CS AUB (pCSAUB).

Study design

The case notes of 57 women with pCSAUB who had undergone a resectoscopic remodeling procedure were reviewed retrospectively. Primary outcome measures were the duration of preoperative and postoperative menstruation, and postoperative menstrual change. Secondary outcome measures were the impact of patient-dependent variables on the success of the resectoscopic remodeling procedure. The CS scar was located using transvaginal ultrasonography and hysteroscopy. The remodeling procedure was performed with a hysteroscopic resectoscope, and commenced with resection of the fibromuscular scar. This started at the roof of the scar pouch and progressed towards the external os. It then continued along a line parallel to the axis of the cervical canal. The exposed dilated blood vessels and endometrial-like tissue in the roof of the remaining pouch were electrocauterized with a roller-ball electrode.

Results

The mean operating time was 30.2 ± 6.6 min. There was a significant difference in the mean duration of preoperative and postoperative menstruation (12.9 ± 2.9 days and 9.4 ± 4.1 days, respectively; p < 0.001). However, only 59.6% of patients (34/57) reported a postoperative improvement in symptoms. A significant postoperative improvement was observed more frequently in patients with anteflexed uteri than in patients with retroflexed uteri, and this difference was significant (90.6% (29/32) and 20.0% (5/25), respectively; p < 0.001). No correlations were found between treatment outcome and age, body weight, parity, number of cesarean deliveries, duration of preoperative menstruation, or operating time.

Conclusions

Resectoscopic uterine remodeling is an appropriate therapy in patients with pCSAUB and an anteflexed uterus.     

Fetal survival following posterior uterine wall rupture during labour with intact previous caesarean section scar

Introduction Posterior wall rupture of the uterus in presence of previous caesarean scar is an extremely rare and unpredictable event. Case report A 26-year old lady in her second pregnancy went into spontaneous labour at 41 weeks gestation. She had emergency caesarean section in her previous pregnancy. She made slow progress in labour to full dilatation without augmentation, but was noted to have fresh vaginal bleeding and breakthrough pain despite an epidural. Uterine scar rupture was suspected and an emergency lower segment caesarean section was carried out. Fresh intraperitoneal bleeding was noted but with an intact previous scar. The baby was delivered in good condition. A vertical posterior uterine wall rupture of the lower segment, 5 cm in length, was found to be bleeding profusely and was successfully repaired. Discussion Uterine rupture is a rare but serious complication. Usually the rupture occurs through the previous uterine scar. There are only four reported cases in the literature of posterior uterine rupture in labour through “healthy” uterine tissue in women with previous caesarean section. This is the first instance of fetal survival. The exact mechanism is unknown but likely to be a combination of factors including prostaglandin use, element of obstruction and strong inelastic scar. Conclusion Strict vigilance is required during labour in women with previous scar. Early recognition of imminent scar rupture should speed delivery and improve the outcome for mother and baby.     

剖宫产瘢痕处早期妊娠临床特点及处理

目的　探讨剖宫产子宫瘢痕处妊娠的病例特点和处理方法。　方法　回顾性分析2 0 0 0年 4月至 2 0 0 3年 3月收治的 5例子宫下段剖宫产瘢痕处妊娠患者临床资料。　结果　 5例患者停经 6～ 8周后均有无痛性不规则阴道出血 ,5例患者均在超声监测下行清宫术 ,取得良好结局 ,无一例发生大流血或子宫切除。　结论　有剖宫产史的患者再次妊娠时 ,有发生子宫瘢痕处妊娠的可能 ,诊断时尤其要注意该病的临床特点 ,为防止子宫穿孔可采取超声监测下清宫术及辅助局部氨甲喋呤注射、纱布填塞创面止血等方法。术后应继续进行血hCG、超声等监测。降低剖宫产率和产后严格避孕是主要的预防办法。