在中期分娩后刮宫期间进行术中超声引导与更高的并发症发生率相关。

Intraoperative Ultrasound Guidance During Curettage After Second-Trimester Delivery is Associated With a Higher Rate of Complications.

机构信息

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

出版信息

J Obstet Gynaecol Can. 2020 Sep;42(9):1080-1085. doi: 10.1016/j.jogc.2020.02.115. Epub 2020 Apr 25.

DOI:10.1016/j.jogc.2020.02.115

PMID:32345554

Abstract

OBJECTIVE

The use of intraoperative ultrasound guidance for second-trimester elective dilation and curettage reduces the incidence of uterine perforation. However, the role of intraoperative ultrasound guidance during curettage following second-trimester delivery has not been evaluated. We aim to evaluate the effect of intraoperative ultrasound guidance during curettage following second-trimester delivery.

METHODS

We conducted a retrospective cohort study that included patients who had a second-trimester delivery at up to 23 weeks gestation and underwent uterine curettage after the fetus was delivered.

RESULTS

Overall, 273 patients were included. Of them, 194 (71%) underwent curettage without intraoperative ultrasound guidance, while 79 (29%) underwent the procedure utilizing intraoperative ultrasound guidance. The overall rate of a composite adverse outcome was higher among those undergoing curettage under intraoperative ultrasound guidance compared with no ultrasound guidance (31 [39.2%] vs. 40 [20.6%]; OR 2.4; 95% CI 1.4-4.4, P = 0.002). Placental morbidity (10 [12.6%] vs. 11 [5.6%]; OR 1.9; 95% CI 1.01-5.9, P = 0.04) and infectious complications (6 [7.5%] vs. 5 [2.5%]; OR 3.1; 95% CI 1.01-10.4, P = 0.05) were more frequent among those undergoing curettage with intraoperative ultrasound guidance. In a multivariate logistic regression analysis, intraoperative ultrasound guidance was the only independent factor positively associated with the occurrence of an adverse outcome (adjusted OR 1.93; 95% CI 1.1-3.4, P = 0.02). Procedure time was longer when ultrasound guidance was used (9:52 vs. 6:58 min:s; P < 0.001).

CONCLUSION

Intraoperative ultrasound guidance during curettage after second-trimester delivery is associated with a higher complication rate than no guidance.

摘要

目的

在中孕期选择性扩张和刮宫时使用术中超声引导可降低子宫穿孔的发生率。然而，在中期分娩后刮宫时使用术中超声引导的作用尚未得到评估。我们旨在评估在中期分娩后刮宫时使用术中超声引导的效果。

方法

我们进行了一项回顾性队列研究，该研究纳入了在妊娠 23 周之前进行中孕期分娩并在胎儿娩出后进行子宫刮宫的患者。

结果

总体而言，共纳入 273 例患者。其中，194 例（71%）未在术中超声引导下行刮宫术，而 79 例（29%）在术中超声引导下行刮宫术。在接受术中超声引导下刮宫术的患者中，复合不良结局的总体发生率高于未接受超声引导下刮宫术的患者（31 [39.2%] 比 40 [20.6%]；OR 2.4；95%CI 1.4-4.4，P=0.002）。胎盘发病率（10 [12.6%] 比 11 [5.6%]；OR 1.9；95%CI 1.01-5.9，P=0.04）和感染性并发症（6 [7.5%] 比 5 [2.5%]；OR 3.1；95%CI 1.01-10.4，P=0.05）在接受术中超声引导下刮宫术的患者中更为常见。在多变量逻辑回归分析中，术中超声引导是唯一与不良结局发生呈正相关的独立因素（校正 OR 1.93；95%CI 1.1-3.4，P=0.02）。使用超声引导时，手术时间较长（9:52 比 6:58 分钟：秒；P<0.001）。