Cesarean Scar Pregnancy Clinical Analysis Of 8 Cases

Objective: Cesarean section uterine scar pregnancy is short for cesarean scar pregnancy(CSP). It refers to Pregnant capsule, the villi or embryo implanted in the previous incision scar of the lower uterine segment, And it is ofen misdiagnosed as intrauterine pregnancy to operate artificial abortion,or curettage to cause fatal bleeding. The CSP is a Complication of the cesarean section, and it is not a common disease in Obstetrics and Gynecology. At present,it has been gradually recognized that cesarean section scar pregnancy risk. If not timely diagnosis or the wrong treatment, in early pregnancy can be a severe vaginal bleeding, Even spontaneous perforation of uterine scar or Curettage perforation, and a large number of internal bleeding. To late pregnancy and uterine rupture can occur endanger pregnant woman. Therefore, early detection of cesarean scar pregnancy and in accordance with specific circumstances to take effective measures is the key to dealing with the disease. This paper mainly discusses the clinical features of the cesarean scar pregnancy and provides clinical basis for the early diagnosis and treatment of this disease.Methods: Analyzed retrospectively the clinical data of eight patients with cesarean scar pregnancy in the Second Affiliated Hospital of Dalian Medical University and Heilongjiang Province hospital from January 2005 to December 2007, including age of the patients, the frequency of pregnancy bearing. the interval from the last cesarean delivery to diagnosis, clinical manifestations, diagnosis, the process and the outcome of diagnosis and treatment.Results:The average onset age of the 8 patients was 31.13±4.49 years old, they all had a history of cesarean section. The interval of the incidence of the cesarean section from the previous time to now is about 7 months to 13 years. There were seven cases in the 8 patients are painless irregular vaginal bleeding as the main symptom. One case is have non-clinical performance characteristics.The bloody means of the seven cases of vaginal bleeding as follows: Three cases took place bleeding in the course of abortion, one case took place irregular vaginal bleeding after drug-induced abortion, 3 patients took place irregular vaginal bleeding in the case of not undergoing any treatment. Five cases in the 8 patients were diagnosed by ultrasound examination. One case was diagnosed unclear by the ultrasound examination, then was confirmed by the nuclear magnetic resonance (MRI) examination. Two cases were diagnosed unclear by the ultrasound examination, then confirmed by pathological examination after the laparotomy. Four cases in the 8 patients were performed with ultrasound-guided curettage after the conservative drug treatment. Two cases were treated with uterine artery embolization (UAE). Two cases were performed hysterectomy because of the uncontrollable vaginal bleeding and the unable to repair scar parts. And the last, the eight patients were cured and discharged.Conclusions:1. Because Cesarean section scar pregnancy (CSP) can occur vaginal bleeding and lead to hemorrhagic shock and hysterectomy, so it is a very dangerous type of pregnancy. Early diagnosis and correctly handle of the disease is essential.2. In the diagnosis of the disease, we should be combined with their cesarean history of the disease, clinical signs and symptoms, use a variety of means as The B-mode ultrasonography and MRI to support inspection to make a comprehensive judgement.3. In the treatment of this disease , for those early diagnosis is clear and had not vaginal bleeding or had a small amount of vaginal bleeding, we can first try drugs conservative treatment. For those who have a vaginal bleeding, the preferred treatment is the interventional treatment to stop bleeding rapidly.With particular emphasis on uterine artery embolization (UAE) in the treatment of difficult to control when the advantages of vaginal bleeding. UAE could be effective hemostasis, it can avoid hysterectomy when the Pregnant capsule invasive uterine wall of the more superficial. If the intervention therapy or Pelvic vascular ligation such as uterine artery or Iliac artery can not to stop bleeding, we should consider laparotomy, in accordance with the specific circumstances to decide the surgical operation.