Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker-Enfants Malades, Université Paris Descartes, Paris, France.
Am J Obstet Gynecol. 2011 Dec;205(6):551.e1-6. doi: 10.1016/j.ajog.2011.06.104. Epub 2011 Jul 13.
The objective of the study was to describe the assessment of lower segment uterine scar (LSCS) by transvaginal ultrasound (TVUS) during a first-trimester scan.
Patients with a history of LSCS were prospectively enrolled over a 6 month period. Four groups were defined: type 1A, thin scar within cervicoisthmic canal (CIC); type 1B, thin above the internal os (IO); type 2A, dehiscent within the CIC; type 2B, dehiscent above the IO. Accuracy of first-trimester TVUS was investigated by blind testing a panel of 14 operators over a web-based dataset.
The scar was visualized in 122 of 123 patients enrolled. Types 1A, 1B, 2A, and 2B occurred in 49.2%, 3.3%, 38.3%, and 9.2%, respectively. When blind tested, fetal medicine specialists achieved a median sensitivity of 82% and specificity of 100% for the detection of a scar. These were 83% and 87% for nonspecialists.
First-trimester uterine scar assessment may become a valuable tool in early recognition of patients at risk of subsequent perinatal complications.
本研究旨在描述经阴道超声（TVUS）在早孕期扫描中对下段子宫瘢痕（LSCS）的评估。
前瞻性纳入了 6 个月内有 LSCS 病史的患者。将其分为 4 组：1A 型，宫颈内口（CIC）内薄瘢痕；1B 型，内口上方薄瘢痕；2A 型，CIC 内破裂；2B 型，内口上方破裂。通过对 14 名操作人员的基于网络的数据集进行盲测，研究了早孕期 TVUS 的准确性。
在纳入的 123 名患者中，122 名患者的瘢痕可见。分别有 49.2%、3.3%、38.3%和 9.2%的患者为 1A 型、1B 型、2A 型和 2B 型。在盲测中，胎儿医学专家对瘢痕的检测灵敏度中位数为 82%，特异性为 100%；非专家的灵敏度和特异性分别为 83%和 87%。
早孕期子宫瘢痕评估可能成为早期识别有潜在围产期并发症风险患者的有价值的工具。
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