通过超声评估子宫下段预测完全性子宫破裂
Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment.
作者信息
Bujold Emmanuel, Jastrow Nicole, Simoneau Jessica, Brunet Suzanne, Gauthier Robert J
机构信息
Department of Obstetrics and Gynaecology, Faculty of Medicine, Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, QC, Canada.
出版信息
Am J Obstet Gynecol. 2009 Sep;201(3):320.e1-6. doi: 10.1016/j.ajog.2009.06.014.
OBJECTIVE
The purpose of this study was to establish the validity of sonographic evaluation of lower uterine segment (LUS) thickness for complete uterine rupture.
STUDY DESIGN
A prospective cohort study of women with previous cesarean delivery was conducted. LUS thickness (full thickness and myometrial thickness only) was measured between 35 and 38 weeks gestation, and the thinnest measurement was considered to be the dependent variable. Receiver operating curve analyses and logistic regression were used.
RESULTS
Two hundred thirty-six women were included in the study. Nine uterine scar defects (3 cases of complete rupture during a trial of labor and 6 cases of dehiscence) were reported. Receiver operating curve analyses showed that full thickness of <2.3 mm was the optimal cutoff for the prediction of uterine rupture (3/33 vs 0/92; P = .02). Full thickness was also identified as an independent predictor of uterine scar defect (odds ratio, 4.66; 95% confidence interval, 1.04-20.91)
CONCLUSION
Full LUS thickness of <2.3 mm is associated with a higher risk of complete uterine rupture.
目的
本研究的目的是确定超声评估子宫下段（LUS）厚度对诊断完全性子宫破裂的有效性。
研究设计
对有剖宫产史的女性进行一项前瞻性队列研究。在妊娠35至38周期间测量LUS厚度（仅全层厚度和肌层厚度），最薄测量值被视为因变量。采用受试者工作特征曲线分析和逻辑回归。
结果
236名女性纳入研究。报告了9例子宫瘢痕缺陷（3例试产期间完全破裂和6例裂开）。受试者工作特征曲线分析显示，全层厚度<2.3mm是预测子宫破裂的最佳临界值（3/33 vs 0/92；P = 0.02）。全层厚度也被确定为子宫瘢痕缺陷的独立预测因素（比值比，4.66；95%置信区间，1.04 - 20.91）
结论
子宫下段全层厚度<2.3mm与完全性子宫破裂的较高风险相关。
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