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中华产科急救电子杂志 ›› 2025, Vol. 14 ›› Issue (01) : 8 -14. doi: 10.3877/cma.j.issn.2095-3259.2025.01.003

瘢痕子宫再妊娠系列问题

瘢痕子宫再妊娠的孕前评估与处理
吴章鑫1, 吴郁1,()   
  1. 1. 100191 北京大学第三医院妇产科
  • 收稿日期:2023-08-10 出版日期:2025-02-18
  • 通信作者: 吴郁
  • 基金资助:
    首都卫生发展科研专项(2024-1-4094)

Pre-pregnaney evaluation and management of scarred uterus re-pregnancy

Zhangxin Wu, Yu Wu()   

  • Received:2023-08-10 Published:2025-02-18
  • Corresponding author: Yu Wu
引用本文:

吴章鑫, 吴郁. 瘢痕子宫再妊娠的孕前评估与处理[J/OL]. 中华产科急救电子杂志, 2025, 14(01): 8-14.

Zhangxin Wu, Yu Wu. Pre-pregnaney evaluation and management of scarred uterus re-pregnancy[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2025, 14(01): 8-14.

本文探讨了瘢痕子宫再妊娠的孕前评估与处理策略,强调了准确评估子宫瘢痕愈合情况的重要性,同时提出一系列孕前评估方法和处理措施;文中讨论了影响剖宫产及子宫肌瘤剔除术后瘢痕愈合的多种因素,并提出相应的评估方法,如经阴道超声、宫腔超声造影、磁共振成像和宫腔镜检查等。 此外,还介绍了剖宫产瘢痕憩室的临床分级,为临床决策提供了参考,对于剖宫产瘢痕愈合不良的手术处理,也给出了建议。

This article comprehensively examines prenatal assessment and treatment strategies for re-pregnancy in the context of a scarred uterus. It underscores the significance of accurately evaluating the healing status of uterine scars and proposes a series of pre-pregnancy assessment methods and treatment interventions. The discussion delves into the various factors influencing scar healing following cesarean sections and myomectomies, and recommends corresponding assessment techniques, including transvaginal ultrasound, hysteroscopic contrast ultrasound, magnetic resonance imaging, and hysteroscopy.Furthermore, the article introduces a clinical grading system for cesarean scar diverticulum, which is a valuable reference for clinical decision-making. Additionally, it offers suggestions for the surgical management of poorly healing cesarean scars.

表1 剖宫产瘢痕憩室分级[14]
[1]
刘维芳, 邹丽. 瘢痕子宫再次妊娠的并发症管理[J/CD]. 中华产科急救电子杂志,2020,9(2):78-82.
[2]
刘彩, 赵先兰. 瘢痕子宫再次妊娠的时机、风险及早期识别[J/CD]. 中华产科急救电子杂志,2020,9(2):69-73.
[3]
Betran AP, Ye J, Moller AB, et al. Trends and projections of caesarean section rates: global and regional estimates[J]. BMJ Glob Health,2021,6(6):e005671.
[4]
Feng XL, Wang Y, An L, et al. Cesarean section in the People′s Republic of China: current perspectives[J]. Int J Womens Health,2014,6:59-74.
[5]
陈京亭. 影响剖宫产子宫切口愈合的相关因素分析[J]. 安徽医药,2013,17(6):989-991.
[6]
Chen Y, Han P, Wang YJ, et al. Risk factors for incomplete healing of the uterine incision after cesarean section[J]. Arch Gynecol Obstet,2017,296(2):355-361.
[7]
Paping A, Basler C, Ehrlich L, et al. Uterine scars after caesarean delivery: from histology to the molecular and ultrastructural level[J]. Wound Repair Regen,2023,31(6):752-763.
[8]
Yazicioglu HF, Sevket O, Ekin M, et al. Incomplete healing of the uterine incision after cesarean section: is it preventable by intraoperative digital dilatation of the internal cervical ostium?[J]. Gynecol Obstet Invest,2012,74(2):131-135.
[9]
Yazicioglu F, Gökdogan A, Kelekci S, et al. Incomplete healing of the uterine incision after caesarean section: is it preventable?[J]Eur J Obstet Gynecol Reprod Biol,2006,124(1):32-36.
[10]
Tekelioˇglu M, Karataş S, Güralp O, et al. Incomplete healing of the uterine incision after elective second cesarean section[J]. J Matern Fetal Neonatal Med,2021,34(6):943-947.
[11]
Sevket O, Takmaz T, Ozcan P, et al. Hydrosonographic assessment of the effect of two different suture materials on healing of the uterine scar after cesarean delivery: a prospective randomized controlled trial[J]. Z Geburtshilfe Neonatol,2021,225(2):140-145.
[12]
Başbuˇg A, Doˇgan O, Ellibeş Kaya A, et al. Does suture material affect uterine scar healing after cesarean section? Results from a randomized controlled trial[J]. J Invest Surg,2019,32(8):763-769.
[13]
Roberge S, Boutin A, Chaillet N, et al. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect[J]. Am J Perinatol,2012,29(6):465-471.
[14]
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.
[15]
Ofili-Yebovi D, Ben-Nagi J, Sawyer E, et al. Deficient lowersegment cesarean section scars: prevalence and risk factors[J].Ultrasound Obstet Gynecol,2008,31(1):72-77.
[16]
Regnard C, Nosbusch M, Fellemans C, et al. Cesarean section scar evaluation by saline contrast sonohysterography [ J].Ultrasound Obstet Gynecol,2004,23(3):289-292.
[17]
Kulshrestha V, Agarwal N, Kachhawa G. Post-caesarean niche(isthmocele) in uterine scar: an update[J]. J Obstet Gynaecol India,2020,70(6):440-446.
[18]
Vitale SG, Ludwin A, Vilos GA, et al. From hysteroscopy to laparoendoscopic surgery: what is the best surgical approach for symptomatic isthmocele? A systematic review and meta-analysis[J]. Arch Gynecol Obstet,2020,301(1):33-52.
[19]
Abacjew-Chmylko A, Wydra DG, Olszewska H. Hysteroscopy in the treatment of uterine cesarean section scar diverticulum: a systematic review[J]. Adv Med Sci,2017,62(2):230-239.
[20]
Tsuji S, Takahashi A, Higuchi A, et al. Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome[J]. PLoS One,2020,15(12):e0243421.
[21]
Mashiach R, Burke YZ. Optimal isthmocele management:hysteroscopic,laparoscopic,or combination[J]. J Minim Invasive Gynecol,2021,28(3):565-574.
[22]
Al Mutairi BH, Alrumaih I. Hysteroscopy in the treatment of myometrial scar defect (diverticulum) following cesarean section delivery: a systematic review and meta-analysis[J]. Cureus,2020,12(11):e11317.
[23]
Vervoort A, van der Voet LF, Hehenkamp W, et al.Hysteroscopic resection of a uterine caesarean scar defect (niche)in women with postmenstrual spotting: a randomised controlled trial[J]. BJOG,2018,125(3):326-334.
[24]
Marotta ML, Donnez J, Squifflet J, et al. Laparoscopic repair of post-cesarean section uterine scar defects diagnosed in nonpregnant women[J]. J Minim Invasive Gynecol,2013,20(3):386-391.
[25]
Yalcinkaya TM, Akar ME, Kammire LD, et al. Robotic-assisted laparoscopic repair of symptomatic cesarean scar defect:a report of two cases[J]. J Reprod Med,2011,56(5-6):265-270.
[26]
Zhang Y. A comparative study of transvaginal repair and laparoscopic repair in the management of patients with previous cesarean scar defect[J]. J Minim Invasive Gynecol,2016,23(4):535-541.
[27]
Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, et al. Trial of labor after myomectomy and uterine rupture:a systematic review[J]. Acta Obstet Gynecol Scand,2016,95(7):724-734.
[28]
Zaami S,Montanari Vergallo G,Malvasi A,et al. Uterine rupture during induced labor after myomectomy and risk of lawsuits[J].Eur Rev Med Pharmacol Sci,2019,23(4):1379-1381.
[29]
Claeys J,Hellendoorn I,Hamerlynck T,et al. The risk of uterine rupture after myomectomy:a systematic review of the literature and meta-analysis[J]. Gynecol Surg,2014,11:197-206.
[30]
Gil Y, Badeghiesh A, Suarthana E, et al. Risk of uterine rupture after myomectomy by laparoscopy or laparotomy[J]. J Gynecol Obstet Hum Reprod,2020,49(8):101843.
[31]
Hurst BS, Matthews ML, Marshburn PB. Laparoscopic myomectomy for symptomatic uterine myomas[J]. Fertil Steril,2005,83(1):1-23.
[32]
Parker WH, Iacampo K, Long T. Uterine rupture after laparoscopic removal of a pedunculated myoma[J]. J Minim Invasive Gynecol,2007,14(3):362-364.
[33]
子宫肌瘤的诊治中国专家共识专家组. 子宫肌瘤的诊治中国专家共识[J]. 中华妇产科杂志,2017,52(12):793-800.
[34]
Tinelli A, Hurst BS, Mettler L, et al. Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study[J]. Hum Reprod,2012,27(9):2664-2670.
[35]
Tsuji S, Takahashi K, Imaoka I, et al. MRI evaluation of the uterine structure after myomectomy[J]. Gynecol Obstet Invest,2006,61(2):106-110.
[36]
Abbas A, Michael A, Ali MA, et al. Recurrent spontaneous third-trimester uterine rupture after hysteroscopic resection of myoma: a case report[J]. Proceedings Obstet Gynecol,2017,7(3):1-7.
[37]
Sentilhes L, Sergent F, Popovic I, et al. Factors predictive of uterine rupture after operative hysteroscopy[J]. J Gynecol Obstet Biol Reprod (Paris),2004,33(1 Pt 1):51-55.
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