Wang L L, Yang H X, Chen J Y, Fan L X, Zhang X X
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Zhonghua Fu Chan Ke Za Zhi. 2022 Aug 25;57(8):587-593. doi: 10.3760/cma.j.cn112141-20220107-00011.
To investigate the pregnancy outcomes of pregnant women with cesarean scar diverticulum (CSD) and to find the relevant factors that predict the occurrence of adverse pregnancy outcomes. From January 2015 to March 2019, 501 singleton pregnant women with a history of cesarean section who underwent regular prenatal examination in early pregnancy and eventually delivered in Peking University First Hospital were prospectively collected. According to the presence or absence of CSD in the first trimester of pregnancy, the pregnant women were divided into the CSD group (=127, 25.3%) and the non-CSD group (374, 74.7%). According to the mode of delivery and the classification of the lower uterine segment seen during cesarean section, the CSD group was further divided into the non-rupture group (including spontaneous delivery and lower uterine segment grade Ⅰ;=108, 85.0%) and rupture group (including lower uterine segment grade Ⅱ-Ⅳ;=19, 15.0%). The general clinical data, pregnancy outcomes, diverticulum-related indexes [including length, width, depth (D), average diameter, volume, and residual myometrial thickness (RMT)] were compared. The predictive values of D/adjacent myometrial thickness≥50%, RMT≤2.2 mm and D/RMT>1.3 for uterine rupture in CSD pregnant women were verified. (1) Comparison between CSD group and non-CSD group: the lower uterine segment thickness in the third trimester of pregnancy in the CSD group was lower than that in the non-CSD group [(1.2±0.5) vs (1.4±0.6) mm, respectively], and the incidence of uterine rupture was higher than that in the non-CSD group [15.0% (19/127) vs 8.0% (30/374), respectively], and the differences were statistically significant (both <0.05). There were no significant differences in other clinical data and pregnancy outcomes between the two groups (all >0.05). (2) Comparison of rupture group and non-rupture group: the lower uterine segment thickness in the third trimester of pregnancy in rupture group [(0.6±0.5) mm] was lower than that in non-rupture group [(1.2±0.6) mm], and the difference was statistically significant (=3.486, =0.001). There were no significant differences in diverticulum-related indexes between the two groups (all >0.05). (3) Relationship between high risk predictors of uterine rupture and actual uterine rupture: the sensitivity of D/adjacent muscle thickness ≥50%, RMT≤2.2 mm and D/RMT>1.3 in predicting the high risk of uterine rupture were 94.7%, 57.9% and 73.6%, the specificity were 12.0%, 40.7% and 24.1%, the positive predictive value were 15.9%, 14.7%, 14.6%, and the negative predictive value were 92.8%, 84.6%, 83.9%, respectively. The risk of uterine rupture in pregnant women with CSD is higher than that in those without CSD. There is no significant correlation between CSD related indexes and uterine rupture in the first trimester. Monitoring the lower uterine segment thickness in the third trimester might be helpful to predict the occurrence of adverse pregnancy outcomes.
探讨剖宫产瘢痕憩室（CSD）孕妇的妊娠结局，并寻找预测不良妊娠结局发生的相关因素。前瞻性收集2015年1月至2019年3月在北京大学第一医院进行早孕定期产前检查并最终分娩的501例有剖宫产史的单胎孕妇。根据妊娠早期是否存在CSD，将孕妇分为CSD组（=127例，25.3%）和非CSD组（374例，74.7%）。根据分娩方式及剖宫产术中所见子宫下段分类，CSD组进一步分为未破裂组（包括自然分娩及子宫下段Ⅰ级；=108例，85.0%）和破裂组（包括子宫下段Ⅱ-Ⅳ级；=19例，15.0%）。比较一般临床资料、妊娠结局、憩室相关指标[包括长度、宽度、深度（D）、平均直径、体积及残余肌层厚度（RMT）]。验证D/相邻肌层厚度≥50%、RMT≤2.2mm及D/RMT>1.3对CSD孕妇子宫破裂的预测价值。（1）CSD组与非CSD组比较：CSD组妊娠晚期子宫下段厚度低于非CSD组[分别为（1.2±0.5）mm和（1.4±0.6）mm]，子宫破裂发生率高于非CSD组[分别为15.0%（19/127）和8.0%（30/374）]，差异有统计学意义（均<0.05）。两组其他临床资料及妊娠结局差异无统计学意义（均>0.05）。（2）破裂组与未破裂组比较：破裂组妊娠晚期子宫下段厚度[（0.6±0.5）mm]低于未破裂组[（1.2±0.6）mm]，差异有统计学意义（=3.486，=0.001）。两组憩室相关指标差异无统计学意义（均>0.05）。（3）子宫破裂高危预测指标与实际子宫破裂的关系：D/相邻肌层厚度≥50%、RMT≤2.2mm及D/RMT>1.3预测子宫破裂高危的敏感度分别为94.7%、57.9%和73.6%，特异度分别为12.0%、40.7%和24.1%，阳性预测值分别为15.9%、14.7%、14.6%，阴性预测值分别为92.8%、84.6%、83.9%。CSD孕妇子宫破裂风险高于无CSD孕妇。孕早期CSD相关指标与子宫破裂无明显相关性。监测妊娠晚期子宫下段厚度可能有助于预测不良妊娠结局的发生。
