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中华产科急救电子杂志 ›› 2020, Vol. 09 ›› Issue (04) : 217 -221. doi: 10.3877/cma.j.issn.2095-3259.2020.04.007

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剖宫产子宫瘢痕缺损的评估及再次妊娠的孕期监测
韩振艳1, 侯红瑛1,()   
  1. 1. 510630 广州,中山大学附属第三医院产科
  • 收稿日期:2020-05-08 出版日期:2020-11-18
  • 通信作者: 侯红瑛

Assessment of Cesarean Scar Defect and Surveillance during Subsequent Pregnancy

Zhenyan Han1, Hongying Hou1()   

  • Received:2020-05-08 Published:2020-11-18
  • Corresponding author: Hongying Hou
引用本文:

韩振艳, 侯红瑛. 剖宫产子宫瘢痕缺损的评估及再次妊娠的孕期监测[J]. 中华产科急救电子杂志, 2020, 09(04): 217-221.

Zhenyan Han, Hongying Hou. Assessment of Cesarean Scar Defect and Surveillance during Subsequent Pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2020, 09(04): 217-221.

剖宫产子宫瘢痕缺损是剖宫产术后最常见的远期并发症,主要通过阴道超声或宫腔声学超声造影来诊断和评估,其独立危险因素包括多次剖宫产史、子宫切口过低及后屈子宫。剖宫产子宫瘢痕缺损再次妊娠后,早孕期应通过阴道超声排除瘢痕妊娠;中晚孕期应关注子宫下段瘢痕及胎盘附着情况,以早期发现子宫破裂、前置胎盘及胎盘植入性疾病等并发症。

Cesarean scar defect is the most common long-term complication after cesarean section, and its diagnosis and assessment mainly through transvaginal ultrasound and sonohysterography. The independent risk factors include multiple cesarean sections, lower cesarean incision and retroflexed uterus. During subsequent pregnancy, an early transvaginal ultrasound is necessary to rule out the cesarean scar pregnancy. In the second and third trimester, more attention should be paid to uterine scar condition and placenta adherence, in order to early identify uterine rupture, placenta previa and placenta accreta spectrum disorders.

图1 阴道超声在子宫正中矢状切面测量CSD的标准[11]。RMT:残余肌层厚度;D:CSD的深度;W:CSD的宽度,C:CSD距离宫颈内口的距离
图2 阴道超声在子宫横切面测量CSD的长度[6]
图3 阴道超声测量CSD和膀胱阴道折图[10]。a:红色和绿色部分为CSD的主要部分,蓝色区域为CSD的分支;b:绿色线条代表膀胱子宫折(Vesicouterine fold),红色线条代表膀胱阴道折(Vesicovaginal fold)
[1]
Betrán AP, Ye J, Moller AB, et al. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014 [J]. PLoS One, 2016, 11(2): e0148343.
[2]
Betran AP, Torloni MR, Zhang JJ, et al. WHO Statement on Caesarean Section Rates [J]. BJOG, 2016, 123(5): 667-670.
[3]
FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders [J]. Int J Gynaecol Obstet, 2018, 140(3): 261-290.
[4]
中国人民共和国国家卫生健康委员会.中国妇幼健康事业发展报告(2019) [EB/OL].(2019-05-27)[2020-10-29].

URL    
[5]
Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination [J]. Ultrasound Obstet Gynecol, 2009, 34(1):90-97.
[6]
Naji O, Abdallah Y, Bij De Vaate AJ, et al. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography [J]. Ultrasound Obstet Gynecol, 2012, 39(3): 252-259.
[7]
Bij de Vaate AJ, van der Voet LF, Naji O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review [J]. Ultrasound Obstet Gynecol, 2014, 43(4): 372-382.
[8]
Antila-Långsjö RM, Mäenpää JU, Huhtala HS, et al. Cesarean scar defect: a prospective study on risk factors [J]. Am J Obstet Gynecol, 2018, 219(5): 458 e1-458 e8.
[9]
Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment [J]. Rev Assoc Med Bras (1992), 2019, 65(5): 714-721.
[10]
Jordans IPM, de Leeuw RA, Stegwee SI, et al. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure [J]. Ultrasound Obstet Gynecol, 2019, 53(1): 107-115.
[11]
Pomorski M, Fuchs T, Rosner-Tenerowicz A, et al. Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section [J]. Ginekol Pol, 2017, 88(4): 174-179.
[12]
Tower AM, Frishman GN. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications [J]. J Minim Invasive Gynecol, 2013, 20(5): 562-572.
[13]
Roberge S, Demers S, Berghella V, et al. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis [J]. Am J Obstet Gynecol, 2014, 211(5): 453-460.

URL    
[14]
Kataoka S, Tanuma F, Iwaki Y, et al. Comparison of the primary cesarean hysterotomy scars after single- and double-layer interrupted closure [J]. Acta Obstet Gynecol Scand, 2016, 95(12): 1352-1358.
[15]
Di Spiezio Sardo A, Saccone G, McCurdy R, et al. Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials [J]. Ultrasound Obstet Gynecol, 2017, 50(5): 578-583.
[16]
Stegwee SI, Jordans I, van der Voet LF, et al. Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta-analysis [J]. BJOG, 2018, 125(9): 1097-1108.
[17]
Stegwee SI, Jordans IPM, van der Voet LF, et al. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development-the 2Close study: a multicentre randomised controlled trial [J]. BMC Pregnancy Childbirth, 2019, 19(1): 85.
[18]
Wang CB, Chiu WW, Lee CY, et al. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position [J]. Ultrasound Obstet Gynecol, 2009, 34(1): 85-89.
[19]
Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, et al. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development [J]. Hum Reprod, 2015, 30(12): 2695-2702.
[20]
Timor-Tritsch I, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy A review. [J]. Am J Obstet Gynecol, 2012, 207(1): 14-29.

URL    
[21]
Tanos V, Toney ZA. Uterine scar rupture-Prediction, diagnosis, and management[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 59:115-131.
[22]
Morris H. Surgical pathology of the lower uterine segment cesarean section scar: is the scar a source of clinical symptoms? [J]. Intl J Gynecol Pathol, 1995, 14(1): 16-20.
[23]
Vikhareva Osser O, Valentin L. Clinical importance of appearance of cesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women [J]. Obstet Gynecol, 2011, 117(3): 525-532.
[24]
Gubbini G, Centini G, Nascetti D, et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study [J]. J Minim Invasive Gynecol, 2011, 18(2): 234-237.
[25]
Tanimura S, Funamoto H, Hosono T, el a1. New diagnostic criteria and operative strategy for cesarean scar syndrome:Endoscopic repair for secondary infertility caused by cesarean scar defect [J]. J Obstet Gynaecol Res, 2015, 41(9): 1363-1369.
[26]
Donnez O, Donnez J, Orellana R, et al. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women [J]. Fertil Steril, 2017, 107(1): 289-296. e2.
[27]
洪燕语,贺晶. 剖宫产术后子宫瘢痕憩室孕妇妊娠结局的分析[J]. 中华妇产科杂志,2017, 52(10): 697-700.
[28]
胡珍. 剖宫产瘢痕憩室再生育分娩方式及妊娠结局分析[J]. 中国计划生育学杂志,2019, 27(5): 643-646.
[29]
王林林,陈俊雅,杨慧霞,等.妊娠期子宫瘢痕情况与剖宫产术后再次妊娠孕妇发生子宫破裂的相关性[J]. 中华妇产科杂志,2019, 54(6): 375-380.
[30]
Timor-Tritsch IE, Monteagudo A, Cali G, et al. Cesarean scar pregnancy and early placenta accreta share common histology [J]. Ultrasound Obstet Gynecol, 2014, 43(4): 383-395.
[31]
Timor-Tritsch IE, Monteagudo A, Cali G, et al. Cesarean scar pregnancy is a precursor of morbidly adherent placenta [J]. Ultrasound Obstet Gynecol, 2014, 44(3): 346-353.
[32]
Futyma K, Galczynski K, Romanek K, et al. When and how should we treat cesarean scar defect-isthmocoele? [J]. Ginekol Pol, 2016, 87(9): 664-668.
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