Three Treatments for Cesarean Scar Pregnancy

doi:10.12114/j.issn.1007-9572.2019.07.016

Abstract

Abstract: Background　Cesarean scar pregnancy（CSP） is a serious complication in the early pregnancy.With the implementation of the universal two-child policy，cesarean section rate remains high and the incidence of CSP is increasing. Objective　To evaluate the clinical value and safety of three treatments in the termination of CSP.Methods　The medical records of 44 patients with CSP hospitalized in the First Affiliated Hospital of Anhui University of Science & Technology/Huainan First People's Hospital，from April 2013 to December 2017 were retrospectively analyzed.According to the treatment，they were divided into group A（n=16），group B（n=14） and group C（n=14），receiving uterine artery embolization with B-mode ultrasound-guided uterine curettage，transvaginal removal of ectopic pregnancy tissue with repair of uterine scar，B-mode ultrasound-guided uterine curettage following killing the embryo by methotrexate and mifepristone，respectively.Age，gravidity，number of cesarean sections，duration of menstruation cessation，baseline serum human chorionic gonadotropin（HCG）， intraoperative blood loss，duration of operation，postoperative vaginal bleeding time，duration of antibiotic use，length of stay，time taken for postoperative HCG to fall to the pre-pregnancy level，and occurrence of complications were compared between the three groups.Results　Three groups showed no significant differences in average age，gravidity，number of cesarean sections， duration of menstruation cessation，and baseline HCG level（P>0.05）.The average intraoperative blood loss，duration of operation，postoperative vaginal bleeding time，duration of antibiotic use and length of stay differed significantly across the groups（P<0.05）.The average time taken for postoperative HCG to fall to the pre-pregnancy level in three groups demonstrated no significant differences（P>0.05）.To be specific，pairwise comparisons showed that the average intraoperative blood loss increased successively in groups A，C，and B（P<0.05）.Group B had shorter average duration of operation than other two groups（P<0.05）.The average postoperative vaginal bleeding time of group A was shorter than that of group C（P<0.05）.The average duration of antibiotic use of group A was shorter than that of group B（P<0.05）.Group C had longer length of stay compared with other two groups（P<0.05）.No uterine perforation，abortion-related syndrome，massive hemorrhage，bladder injury and hysterectomy occurred during the operation，and no drug-induced liver and kidney injuries and leukopenia occurred after the operation.Conclusion　Uterine artery embolization with B-mode ultrasound-guided uterine curettage is minimally invasive and safe，but should be selected cautiously for those with fertility needs.Transvaginal removal of ectopic pregnancy tissue with repair of uterine scar has good eradication effect but with higher risks. B-mode ultrasound-guided uterine curettage following killing the embryo by methotrexate and mifepristone is minimally invasive and safe，but need longer length of stay. Therefore，for the termination of CSP，an individualized treatment plan should be formulated according to the patient's condition and fertility need.

Key words: Cesarean scar pregnancy, Cesarean section, Uterine artery embolization, Transvaginal removal of ectopic pregnancy tissue, Repair of uterine scar, Curettage

摘要： 背景　子宫瘢痕妊娠是严重的孕早期并发症，随着二孩政策的放开，剖宫产率居高不下，子宫瘢痕妊娠发病率增高。目的　探讨不同治疗方法终止剖宫产术后子宫瘢痕妊娠（CSP）的应用价值及安全性。方法　回顾性分析2013年4月—2017年12月在安徽理工大学第一附属医院（淮南市第一人民医院）住院的44例CSP患者的病历资料，其中A组（n=16）选择子宫动脉栓塞联合B超引导下清宫术，B组（n=14）选择经阴道妊娠物清除及子宫瘢痕修补术，C组（n=14）选择甲氨蝶呤联合米非司酮药物杀胚后B超引导下清宫术。比较3组患者的年龄、妊娠次数、剖宫产次数、停经时间、术前血人绒毛膜促性腺激素（HCG）水平、术中出血量、手术时间、术后阴道流血时间、抗生素使用时间、住院时间、术后血HCG水平降至正常时间及并发症发生情况。结果　3组CSP患者的年龄、妊娠次数、剖宫产次数、停经时间、术前血HCG水平比较，差异均无统计学意义（P>0.05）。3组患者术中出血量、手术时间、术后阴道流血时间、抗生素使用时间、住院时间比较，差异有统计学意义（P<0.05）；术后血HCG水平降至正常时间比较，差异无统计学意义（P>0.05）。术中出血量，A组<C组<B组（P<0.05）；手术时间，A、C组<B组（P<0.05）；术后阴道流血时间，A组<C组（P<0.05）；抗生素使用时间，A组<B组（P<0.05）；住院时间，A、B组<C组（P<0.05）。3组术中无一例子宫穿孔、人工流产综合征、大出血、膀胱损伤及子宫切除，术后无一例药物性肝肾损害及白细胞计数下降。结论　子宫动脉栓塞联合B超引导下清宫术微创、安全，但有妊娠需求者慎选；经阴道妊娠物清除及子宫瘢痕修补术根治性强，但风险高；药物杀胚后B超引导下清宫术微创安全，但住院时间长。对于CSP的终止，应结合患者自身情况及不同生育需求制定个体化治疗方案。

关键词: 子宫瘢痕妊娠, 剖宫产术, 子宫动脉栓塞术, 经阴道妊娠物清除, 子宫瘢痕修补术, 清宫术

LI Fan,YUAN Lihong,ZHOU Ping. Three Treatments for Cesarean Scar Pregnancy　[J]. Chinese General Practice, 2019, 22(7): 830-833. DOI: 10.12114/j.issn.1007-9572.2019.07.016.
李凡,袁礼红,周萍. 剖宫产术后子宫瘢痕妊娠不同治疗方法的应用价值[J]. 中国全科医学, 2019, 22(7): 830-833. DOI: 10.12114/j.issn.1007-9572.2019.07.016.

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