Clinical significance of ultrasound combined with the measurement of the thickness of the lower part of the anterior wall of the uterine scar in the rational choice of delivery mode for the women of second trimester after cesarean section / 中国基层医药

ABSTRACT

Objective:To evaluate the clinical significance of transabdominal ultrasound combined with transvaginal ultrasound in detecting the thickness of the lower anterior wall of uterine scar in women who are pregnant again after cesarean section.Methods:From August 2017 to August 2019, 180 cases of second pregnancy after cesarean section in late pregnancy who admitted to Zhuji People's Hospital were studied.All patients were examined by transabdominal ultrasound and transvaginal ultrasound at 32, 34, 36 and 38 weeks of gestation respectively.The development rate of scar in the lower segment of uterus was compared between abdominal ultrasound and transvaginal ultrasound.The differences of the thickness of the lower segment of the anterior wall of the uterus in patients with different scar healing grades and the change with the increase of gestation cycle were analyzed.The delivery outcome of the patients was followed up and the statistics was made.The differences of delivery mode and the occurrence of precursory uterine rupture was recorded in different scar healing grades.Results:The uterine scar development rate in women who were pregnant again after cesarean section of abdominal ultrasound combined with transvaginal ultrasound(100.00%, 180/180) was significantly higher than that of abdominal ultrasound(58.89%, 106/180) and vaginal ultrasound(91.11%, 164/180) alone(χ 2=93.147, 16.744, all P<0.001). The difference of the thickness of the lower anterior wall was statistically significant( F=35.716-69.247, all P<0.001). The difference of the thickness of the lower anterior wall of the uterine scar between different gestational periods was statistically significant( F=15.965-24.361, all P<0.001). There were statistically significant differences in delivery mode and incidence of threatened uterine rupture between the groups with different scar healing grades(χ 2=39.669, 8.312, all P<0.001). There were statistically significant differences in the amount of bleeding during delivery and within 24 h after delivery between the groups with different scar healing grades( F=19.635, 27.174, all P<0.001). Conclusion:Abdominal ultrasound combined with transvaginal ultrasound can improve the development rate of uterine scar.Detection of the thickness of the lower part of the anterior wall of uterine scar is helpful to guide women to choose a reasonable mode of delivery after cesarean section, and guide doctors to take timely measures to prevent the risk of delivery.