The Clinical Study Of Ultrasound In The Diagnosis And Treatment Of Cesarean Scar Pregnancy

Part1: The clinical application of ultrasound in the early diagnosis ofcesarean scar pregnancyObjective: To assess the value of ultrasound in the early diagnosis of caesarean scarpregnancy.Methods: Fifty-three patients with cesarean scar pregnancy confirmed by surgery andpathology were reviewed retrospectively, and their clinical features and sonographicappearances were analyzed.Results: Fifty-three patients were classified into two types: the first type included36patients with the placenta and/or a gestational sac embedded in the hysterotomy scar; thesecond type included17patients with abnormal sonographic mass. The main clinicalfeatures for the first type (24/36,66.7%) were amenorrhea and vaginal bleeding, and mostpatients in the second type (14/17,82.4%) were presented with vaginal bleeding orabnormal level in serum β-HCG after dilation and curettage or systemic methotrexateinjection. Among them,48patients (48/53,90.6%) were diagnosed accurately byultrasound.Conclusions: Ultrasound is an effective method for early diagnosis of cesarean scarpregnancy, and it also has an important guiding role in choicing treatment plan andperforming treatment. Part2: The application of intragestational sac administration undersonographic guidance for cesarean scar pregnancyObjective: To evaluate the value of intragestational sac administration ofmethotrexate(MTX) under sonographic guidance in caesarean scar pregnancy(CSP)，and to investigate the effective method for CSP.Methods:36patients of CSP with the gestational sac were randomly classified intotwo groups: A and B. In19patients of A group the gestational sac was injected with50mgof MTX:25mg into the area of the embryo/fetus and25mg into the placental area, andcombined with oral mifepristone. Each patient of B group (17) was administeredintramuscularly with50mg of MTX, and combined with oral mifepristone. Serum humanchorionic gonadotropin（HCG）determinations were obtained and gestational sac volumesand corresponding pulse index(PI), resistance index(RI) were assessed by ultrasoundbefore and the fourth day, the seventh day in a week（D1、D4、D7） after the abovetreatment. Changes of the above observation indicators between D1and D4, D4and D7were analyzed. The effective rate and indicators of serum HCG, gestational sac volume andPI, RI before and after treatment were compared between the two groups.Results: D4after the treatment, typically, there was an initial increase in the serumHCG concentrations as well as in the volume of the gestational sac. D7after the treatment,the above values decreased, the serum HCG of A group(8359.2±6039.7) was markedlylower than that of B group(16974.3±5318.4)（P<0.01）, the volume of the gestationalsac(17.02±2.87) was markedly smaller than that of B group(20.38±4.42)（P<0.01）.Theeffective rate (89.5%,17/19) of A group was significantly higher than that(64.7%,10/17) ofB group（P<0.05）.Before and after treatment, there was slight insignificantly changes inthe value of PI and RI (P>0.05).Conclusions: Combined intragestational MTX injection and oral mifepristonetreatment was effective in treating CSP. It has more effective than intramuscular MTXinjection. It kills the embryo death thoroughly, makes serum HCG value fall faster andshrinks the gestational sac significantly. Side effects of this treatment method were alsosmall. Especially this method can increase the safety of subsequent treatment and preservefertility. Therefore, to patient of CSP with a gestational sac, this method of intragestationalsac administration is safe, effective, cheap and easy to implement, and can be used as firstchoice, especially for in basic-level hospitals.