Case Study On 359 Cases Of Cesarean Scar Pregnancy

Objective:To analyse and summarize of clinical data of 359 cases with cesarean scar pregnancy(CSP),the article provides a basis for standardizing the diagnosis and treatment of CSP.Methods: The clinical data of 359 patients who was diagnosed as CSP from January 1,2012 to December 31,2017 in the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Follow-up data were get through telephone follow-up,outpatient review and medical records.Univariate and multivariate logistic regression analysis was performed on the clinical features of CSP to choose the influencing factors that can assist CSP typing.The ROC curve was used to analyze the diagnostic efficiency of CSP classification.Meanwhile,different treatments in different types of CSP were compared to analysis of advantages and disadvantages and the impact on re-fertility.Results:(1)Days of menopause,the survival of embryos,and the size of gestational sac are relevant influencing factors of the CSP classification.The optimal threshold value of the gestational sac size for predicting type II CSP is 1.95 cm,with a sensitivity of 0.891 and a specificity of 0.187,the optimal cut-off value for predicting(2)type III CSP is 3.25 cm,with a sensitivity of 0.700 and a specificity of 0.625;In type I CSP,In the operation group,the amount of bleeding,blood transfusion,length of hospital stay,and hospitalization expenses were the highest,followed by the curettage group and the least in the medical abortion group.There was no significant difference in blood loss between uterine artery embolization group and non-uterine artery embolization group,as well as drug group and non-drug group(P>0.05).change of β-HCG of drug pretreatment group was larger than the non-drug pretreatment group,and the hospital stay was longer than the non-drug pretreatment group.(3)In type II CSP,the β-HCG value of the curettage group was the most obvious,and the hospitalization days were the shortest.The blood loss,hospitalization days,and hospitalization expenses were the highest in the operation group.The blood loss and hospitalization expenses were the lowest in the drug group,but the hospitalization days were the second long.The blood loss of the uterine artery embolization group was less than that of the non-uterine artery embolization group,and the hospitalization cost was higher.The blood loss of drug pretreatment group was less than that of the non-drug pretreatment group,and change of β-HCG greater.(4)In type III CSP,blood loss changes of β-HCG,length of hospital stay,and number of hospitalizations was not statistically significant in the uterine artery embolization group and non-uterine artery embolization group,as well as in the drug pretreatment group and the non-drug pretreatment group(P>0.05).(5)The fertility of the uterine artery embolization group was lower than that of the non-uterine artery embolization group,and the amount of menstruation was less than that of the non-uterine artery embolization group.Conclusion:(1)The size of the gestational sac is an independent influencing factor of different types of CSP.The higher the gestational sac,the higher the probability of a high-type CSP.(2)Drug therapy is recommended for type I CSP.Curettage can be used as a supplement to drug treatment failure,but UAE is not recommended.(3)For the treatment of type II CSP,patients with no fertility requirements can choose UAE treatment before curettage.operation is only used as a supplement to the failure of curettage which with life-threatening bleeding.It is recommended to take drug treatment before operation if women with fertility requirements.UAE was prepared to prevent the occurrence of postoperative hemorrhage.