CAJ | 학술논문

目的了解剖宫产疤痕缺损(Previous Cesarean Delivery Scar Defect,PCDSD)的患病率及其危险因素.方法对2010年1月至2011年12月在东莞市第三人民医院行剖宫产的妇女(共3500人次)进行电话随访及病历回顾分析,对有症状的患者行阴道B超检查确诊是否存在PCDSD;根据B超检查结果将研究对象分为两组,分别是缺损组和对照组,统计分析母体年龄、孕龄、剖宫产次数、阴道试产情况、缩宫素使用情况、剖宫产指征、羊水浑浊度、子宫缝合层数、手术时间、24 h失血总量、产后母乳喂养时间等因素对PCDSD发生的影响.结果 PCDSD的患病率为22.5％(788/3500).剖宫产次数≥2次、术前使用缩宫素、试产时间≥5h、宫口扩张≥5 cm、胎先露已衔接、产后哺乳≤3个月的孕产妇PCDSD的发生率明显升高.母体年龄、孕龄、剖宫产指征、羊水浑浊度、子宫缝合层数、手术时间、24 h失血量对PCDSD的发生无明显影响.结论剖宫产次数多、术前使用缩宫素、试产时间长、宫口扩张程度大、胎先露已衔接、产后哺乳时间短是PCDSD发生的危险因素,要加强对剖宫产的术前评估及产后康复指导.
목적 료해부궁산파흔결손(Previous Cesarean Delivery Scar Defect,PCDSD)적환병솔급기위험인소.방법 대2010년1월지2011년12월재동완시제삼인민의원행부궁산적부녀(공3500인차)진행전화수방급병력회고분석,대유증상적환자행음도B초검사학진시부존재PCDSD;근거B초검사결과장연구대상분위량조,분별시결손조화대조조,통계분석모체년령、잉령、부궁산차수、음도시산정황、축궁소사용정황、부궁산지정、양수혼탁도、자궁봉합층수、수술시간、24 h실혈총량、산후모유위양시간등인소대PCDSD발생적영향.결과 PCDSD적환병솔위22.5％(788/3500).부궁산차수≥2차、술전사용축궁소、시산시간≥5h、궁구확장≥5 cm、태선로이함접、산후포유≤3개월적잉산부PCDSD적발생솔명현승고.모체년령、잉령、부궁산지정、양수혼탁도、자궁봉합층수、수술시간、24 h실혈량대PCDSD적발생무명현영향.결론 부궁산차수다、술전사용축궁소、시산시간장、궁구확장정도대、태선로이함접、산후포유시간단시PCDSD발생적위험인소,요가강대부궁산적술전평고급산후강복지도.
Objective To investigate the prevalence of previous cesarean delivery scar defect (PCDSD) and its risk factors.Methods 3500 women who had cesarean delivery in our hospital from Jan.2010 to Dec.2011 were followed up by telephone.Two-dimensional transvaginal ultrasound was used to make a definite diagnosis in women who had clinical symptoms.According to ultrasound,they were divided into defect group and control group.Compared age,gestational age,cesarean delivery times,trial of labor situation,oxytocin augmentation during labor,cesarean section indication,amniotic fluid turbidity,layer number of uterus suture,operative time,blood loss in 24 hours and postpartum breast feeding time of two groups.Results The prevalence of PCDSD was 22.5％ (788/3500).The rate of PCDSD was significantly higher among women with cesarean delivery times ≥ 2,oxytocin augmentation during labor,duration of trial of labor ≥ 5 hours,cervix dilation ≥ 5 cm,presenting part below pelvic inlet and postpartum breast feeding time ≤ 3 months.Maternal age,gestational age,cesarean section indication,amniotic fluid turbidity,layer number of uterus suture,operative time,blood loss in 24 hours had no obvious effect on PCDSD.Conclusions Too much cesarean delivery times,oxytocin augmentation during labor,long duration of trial of labor,wide cervix dilation,presenting part below pelvic inlet,and short postpartum breast feeding time are risk factors of PCDSD.We should enhance preoperative assessment and postpartum rehabilitation guidance of cesarean delivery.