The Study On The Value Of Ultrasound In Diagnosis And Classification And Treatment Of Cesarean Scar Pregnancy

ObjectiveIn this study,we retrospectively analyzed the clinical manifestations、serum β-HCG levels and sonographic features in 52 patients who were diagnosed by ultrasound as cesarean scar pregnancy in the First Affiliated Hospital of Chengdu Medical College in the past three years.The purpose of this study is to systematically analyze the ultrasound features of CSP and the relationship between ultrasonic parameters and clinical diagnosis and to compare and analyze the value of different ways of ultrasound scan in the diagnosis of cesarean scar pregnancy.Materials and MethodsA retrospective collection of the Department of Obstetrics and Gynecology at the First Affiliated Hospital of Chengdu Medical College from September 2015 to December 2017,the first diagnosis of 52 cases of cesarean scar pregnancy,all patients were examined by using the Phillips IU22 Color Doppler Ultrasound equipment.The frequency of the probe was 5 to 9 MHz(transvaginal ultrasound)and 3 to 5 MHz(transabdominal ultrasound).By means of transabdominal ultrasound,transvaginal ultrasound,transabdominal ultrasound combined with transvaginal ultrasound,the location and mean diameter of pregnancy tissue,thickness of residual muscle layer,blood supply,peak velocity and the resistance index of trophoblastic blood flow were observed and recorded.The correlation between the above ultrasonic parameters and diagnosis was analyzed.By comparing the results of ultrasonic diagnosis with clinical diagnosis,the accuracy of ultrasonic diagnosis was analyzed,and The accuracy in the diagnosis of CSP by transabdominal ultrasound,transvaginal ultrasound,and transabdominal combined with transvaginal ultrasound were compared and analyzed.ResultsOf all 52 patients,46 were diagnosed with CSP by clinic diagnosis and 6 were diagnosed as non-scarring pregnancy.There was no difference between the general data and the clinical symptoms of the two groups of patients(P>0.05).There was a good correlation between the thickness of residual muscle layer and diagnosis,but there was no significant correlation between other ultrasound parameters(mean diameter ofpregnancy tissue、PSV、 RI)and diagnosis.The diagnostic accuracy of ultrasound was88.4%(46/52),and the misdiagnosis rate was 11.5%(6/52).The results of transabdominal ultrasonography,transvaginal ultrasound,and transabdominal combined with transvaginal ultrasound diagnosis of CSP showed that the diagnostic accuracy rate of abdominal ultrasound group was 71.4%(10/14),and the misdiagnosis rate was28.6%(4/14).The diagnostic accuracy of transvaginal ultrasound was 89.5%(17/19),and the misdiagnosis rate was 10.5%(2/19).The accuracy of transabdominal ultrasound combined with transvaginal ultrasound diagnosis was100%(19/19),and the misdiagnosis rate was 0.0%(0/19).Compared with single transabdominal ultrasound and transvaginal ultrasound,the diagnostic accuracy and misdiagnosis rate of CSP were significantly different in the transabdominal ultrasound combined with transvaginal ultrasound group,and the comparison was statistically significant(P<0.05).The contrast between the transabdominal ultrasound group and the transvaginal ultrasound group showed significant difference between the two groups in the diagnostic accuracy and misdiagnosis rate of CSP.The comparison was statistically significant(P<0.05).ConclusionUltrasound is the preferred imaging method for cesarean scar scar pregnancy.It can perform accurate diagnosis of cesarean scar pregnancy.The thickness of residual muscle layer can be used as an important indication for the diagnosis of CSP.The diagnosis of CSP by transabdominal ultrasound combined with transvaginal ultrasound was superior to that of single abdominal ultrasound or transvaginal ultrasound.ObjectiveThe aim of this study is to present our Ultrasonic classification and theraoeutic stratege for CSP and to evaluated the significance of ultrasound classification in guiding CSP personalized treatment plans.Materials and MethodsRetrospective analysis of 46 patients with cesarean scar pregnancy treated at the First Affiliated Hospital of Chengdu Medical College from September 2015 to December2017,according to the different levels of ultrasound examination results to select a individual theraoeutic stratege,specifically:(1)Direct ultrasound-guided evacuation(Group A): 1 Ultrasound grading 0,irrespective of whether the blood supply is rich or not;2 Ultrasound grading Grade 1,lack of blood supply group.(2)UAE +ultrasound-guided thoracic surgery(B group): 1 ultrasound grade 1,rich blood supply group;2 ultrasound grade 2,regardless of whether the blood supply is rich or not.(3)UAE+ laparoscopic resection and uterine repair(group C): Grade 3ultrasound,regardless of whether the blood supply is rich or not.There were 16 patients in group A,19 in group B,and 11 in group C.The serum β-HCG levels before and after treatment were compared,and the intraoperative blood loss,length of hospital stay,and hospitalization expenses were followed during the treatment.Before the discharge,color Doppler ultrasonography was performed and the results of each group were analyzed.ResultsThere was no significant difference between the general data of each group of patients and there was no statistical significance(P>0.05).In terms of treatment efficiency,the effective rate in Group A was 81.25%,the effective rate in Group B was94.74%,and the effective rate in Group C was 90.91%.The three treatment methods A,B and C had no difference in the treatment efficiency of CSP patients,and they had no statistical significance(P>0.05).On the recovery time of serum β-HCG,there was no statistically significant difference between the three groups(P>0.05).Compared withthe length of hospital stay,the duration of hospital stay was the shortest in group A and the longest stay in group C in the three groups.The difference was statistically significant(P<0.05).In hospitalization costs,hospitalization costs in group A were the lowest,while hospitalization costs in group C were the highest,and the difference between the three groups was statistically significant(P<0.05).Comparing the amount of vaginal bleeding,the amount of blood loss of group A was significantly higher than that in the other two groups.The difference was statistically significant(P<0.05).There was no difference between group B and group C.There was no statistical significance(P>0.05).ConclusionIt is of great clinical value for CSP patients to select appropriate treatment according to the classification of CSP by ultrasound.