| Background and ObjectiveCesarean scar pregnancy(CSP) belongs to a long-term complication of cesarean section, and is a special type of ectopic pregnancy. It is also regarded as the pregnancy in lower uterine segment cesarean section by most domestic literature. The pathogenesis of CSP remains unclear. Some scholors deem that its genesis involves gestational sac implanting into the myometrium via a microscopic tract or sometimes a dehiscence in the previous uterine scar. If blastocyst is convex to cervical canal or uterine cavity, it belongs to the endogenous type. The outcome is likely to continue pregnancy, besides it may form placenta previa, and even can achieve full term pregnancy or live birth. If the sertoli cell infiltrates from cesarean section scar to the muscular layer, then it belongs to the exogenous type, which may have vaginal bleeding in early pregnancy or uterine rupture. So CSP intends to form placenta previa, placenta conglutination, placenta implantation, uterine rupture and other complications. If patients had CSP, who failed to get early diagnosis and proper treatment, they would probably have severe bleeding, and might even need hysterectomy to save their lives. In recent years, with the increasing rate of cesarean section(CS), the prevalence rate of CSP has also been increasing. There is still no consensus on the optimal treatment for CSP among obstetricians. It is probably because of the lack of data on fertility or subsequent pregnancy after treatment for CSP. Thus the subsequent pregnancy of CSP postoperation women becomes the new challenge for the department of obstetrics and gynecology doctors. This study aims to explore the clinical outcome and complications of subsequent pregnancy women with a history of CSP and provide theoretical basis and clinical guidance for postoperative patients with fertility requirements. Materials and methods1. Source of materials: We collected 143 CSP postoperation women who were cured by the First Affiliated Hospital of Zhengzhou University(n=72) and the Second Affiliated Hospital of Zhengzhou University(n=71) during January 2008 to January 2014, randomly selected CS postoperation women from the same period, and followed up their respective subsequent pregnancy situations. The subsequent pregnancy cases were enrolled in this study. The former was the observation group, and the latter was the control group. The previous surgeries of the observation group were performed in the First Affiliated Hospital of Zhengzhou University and the Second Affiliated Hospital of Zhengzhou University, and the control group of that were carried out in the Second Affiliated Hospital of Zhengzhou University. The treatment of observation group was divided into removal of lesions or removal combined with repair, including Hysteroscopic resection, Laparoscopic resection, Hysteroscopy combined with Laparoscopic, Transvaginal surgical treatment, Laparotomy, Uterine artery embolization(UAE) coupled with methotrexate(MTX) arterial injection following dilatation and curettage(D&C). The control group was treated with lower segment transverse cesarean section.2. Method: We retrospectively analyzed 33 subsequent pregnancy women who were diagnosed with CSP, and cured by surgery from January 2008 to January 2014 in the First Affiliated Hospital of Zhengzhou University and the Second Affiliated Hospital of Zhengzhou University, and randomly selected 105 subsequent pregnant women who had a history of CS from the Second Affiliated Hospital of Zhengzhou University at the same period. We recorded gental materials including ages, history of gestation(pregnancy, abortion times, cesarean delivery times), gestational weeks, postoperation, the abnormal situation of the pregnancy(placenta previa, placenta conglutination, placenta implantation, placental abruption, uterine rupture) and the previous surgery time,in order to observe the pregnancy outcomes and complications of two groups. The methods for follow-up included telephone follow-up and the outpatient records to obtain follow-up results. We preserved the cases if we could obtain the results through the two methods, otherwise, we deserted them.3. Statistical methods: We adopted SPSS19.0 software for the clinical data analysis, the two groups’ measurement data using mean ±standard deviation, the comparison of two sets using t test or Kruskal-Wallis, the comparison of count data in two groups using the chi-square test or continuous correction chi-square test. Test alpha=0.05 is considered to be the detection stanard. We used a two-sided distribution. The differential significance is judged by P<0.05. Results1. Comparison between different surgical methods on the subsequent pregnancy rateBetween the patients with CSP repaired surgeries and the ones without CPS repaired surgeries after the removal of the lesions, there was no statistically significant difference( χ2 =0.001,P=1.000>0.05).2. Comparison between observation group and control group in different age, gravidity, parity and cesarean section timesThe observation group was no statistically significant different from control group in age, gravidity and parity(t=-0.660 P=0.510>0.05,t=1.235 P=0.219>0.05,Z=-1.909 P=0.056>0.05). Significant difference was found in cesarean section times between two groups(t=-2.202, P=0.028<0.05). The observation group was significantly higher than that in the control group.3. Comparison between observation group and control group in gestational ageThere were 19 cases in observation group on geatational age < 37weeks(57.58%), respectively 33 cases in control group(31.43%), the overall geatational age in observation group was shorter. Significant difference was found between two groups in gestational age(Z=-2.705,P=0.007<0.05).4. Comparison between observation group and control group in the time interval from the previous surgeryFor the time interval from the previous surgery, observation group showed statistically significant different from control group(Z=-2.386,P=0.018<0.05). The control group were significantly higher than that in observation group.5. Comparison between observation group and control group in incidence of preterm birthFor the incidence of preterm birth, there showed no significant difference between two groups( χ2 =0.001,P=1.000>0.05).6. Comparison between observation group and control group in overall complicationsFor overall complications, such as placenta previa, placental adhesion, placenta accreta, uterine rupture and so on, there showed no statistically difference between two groups( χ2 =0.001,P=1.000>0.05). Conclusions1. In the process of individualized treatment, there was no obvious difference between CSP repaired and CPS unrepaired after surgical removal of the lesionr for the effect of pregnancy situation.2. The overall subsequent pregnancy of the CSP postoperation women was well.3. The overall pregnancy gestational age in the CSP postoperation women was shorter than that in the CS postoperation women.4. Compared with another pregnancy women after CS, the incidence of preterm birth and complications of pregnancy women with CSP surgery showed no obvious difference. |
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