非孕期剖宫产子宫瘢痕评估的系统评价：影像学技术与子宫瘢痕缺陷
Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect.
机构信息
Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada.
出版信息
Am J Perinatol. 2012 Jun;29(6):465-71. doi: 10.1055/s-0032-1304829. Epub 2012 Mar 7.
OBJECTIVE
To review the ability of imaging techniques to predict incomplete healing of uterine cesarean scars before the next pregnancy.
STUDY DESIGN
A systematic literature review searched for studies on women who underwent previous low-transverse cesarean, evaluated by hysterography, sonohysterography (SHG), or transvaginal ultrasound (TVU). The median prevalence of scar defects was computed with 95% confidence intervals (95% CIs). Odds ratio (OR, 95% CI) identified risk factors of incomplete healing.
RESULTS
The analysis included 21 studies. The proportions of suspected scar defects detected by hysterography, SGH, and TVU were 58% (33 to 70), 59% (58 to 85), and 37% (20 to 65), respectively. Two studies found that women with a large uterine scar defect had a higher risk of uterine rupture or uterine scar dehiscence than those with no scar defect or small scar defect (OR: 26.05 [2.36 to 287.61], p <0.001). The only reported risk factor for scar defect was the occurrence of more than one previous cesarean (OR: 2.24 [1.13, 4.45], p = 0.02).
CONCLUSION
Hysterography, SGH, and TVU can detect uterine scar defects in ~50% of women with previous cesarean.
目的
回顾影像学技术在预测下次妊娠前子宫剖宫产瘢痕不完全愈合的能力。
研究设计
系统文献检索了既往行低横向剖宫产术的妇女的研究，这些妇女接受了子宫造影术、超声造影（SHG）或经阴道超声（TVU）检查。计算了瘢痕缺损的中位数患病率及其 95%置信区间（95%CI）。计算了比值比（OR，95%CI）以确定不完全愈合的危险因素。
结果
分析纳入了 21 项研究。子宫造影术、SHG 和 TVU 检测到疑似瘢痕缺损的比例分别为 58%（33%至 70%）、59%（58%至 85%）和 37%（20%至 65%）。两项研究发现，与无瘢痕缺损或小瘢痕缺损的妇女相比，子宫大瘢痕缺损的妇女发生子宫破裂或子宫瘢痕破裂的风险更高（OR：26.05[2.36 至 287.61]，p<0.001）。唯一报道的瘢痕缺损危险因素是既往剖宫产次数超过一次（OR：2.24[1.13 至 4.45]，p=0.02）。
结论
子宫造影术、SHG 和 TVU 可在约 50%的既往剖宫产妇女中检测到子宫瘢痕缺损。
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