Kan Ozgur, Gorkem Umit, Alkilic Aysegul, Cetin Mustafa
Department of Obstetrics and Gynecology, Faculty of Medicine, Hitit University, Corum, Turkey.
Department of Obstetrics and Gynecology, Faculty of Medicine, TOBB University, Ankara, Turkey.
J Obstet Gynaecol Res. 2019 Dec;45(12):2358-2363. doi: 10.1111/jog.14125. Epub 2019 Sep 17.
To evaluate the diagnostic value of striae gravidarum (SG) presence and localization in predicting the intraperitoneal adhesion (IPA) risk in pregnant women with a history of at least one previous cesarean delivery (CD).
A total of 100 pregnant women with repeated CD were included in this prospective observational study. Patients were divided into three groups according to severity of SG with Davey scoring system. Intraoperative adhesion severity and extension were evaluated by using Nair classification system. Moreover, operation duration and neonatal outcomes were analyzed.
Demographic features were comparable between the groups. Adhesion scores were significantly higher in mild and severe SG groups (for mild SG: 1.93 ± 0.99, for severe SG: 2.81 ± 0.88 and for no SG: 1.4 ± 0.57; P < 0.001). Analysis revealed a positive correlation between IPA and severity of SG (P < 0.001). There was a correlation between increased striae density and adhesion severity especially in the right and left upper quadrants of the abdomen (for right quadrant: r = 0.515, P < 0.001; for left quadrant: r = 0.359, P = 0.005).
Our results suggest that preoperative evaluation of SG severity and extend particularly in upper quadrants is a feasible option to predict IPA risk in patients with repeated CD.
评估妊娠纹(SG)的存在及定位对有至少一次剖宫产史(CD)的孕妇发生腹腔内粘连(IPA)风险的诊断价值。
本前瞻性观察性研究共纳入100例有多次剖宫产史的孕妇。采用戴维评分系统根据SG严重程度将患者分为三组。使用奈尔分类系统评估术中粘连的严重程度和范围。此外,分析手术时间和新生儿结局。
各组间人口统计学特征具有可比性。轻度和重度SG组的粘连评分显著更高(轻度SG组:1.93±0.99,重度SG组:2.81±0.88,无SG组:1.4±0.57;P<0.001)。分析显示IPA与SG严重程度之间呈正相关(P<0.001)。妊娠纹密度增加与粘连严重程度之间存在相关性,尤其是在腹部右上象限和左上象限(右上象限:r=0.515,P<0.001;左上象限:r=0.359,P=0.005)。
我们的结果表明,术前评估SG严重程度及范围,尤其是在上象限,是预测多次剖宫产患者IPA风险的可行方法。