Study On The Treatment Of Cesarean Scar Pregnancy And The Reproductive Outcomes

Objective:Cesarean scar pregnancy(CSP)refers to an ectopic pregnancy where the fertilized egg is implanted at the incision scar of the previous cesarean section.At present,the research on the pregnancy outcome of CSP patients after pregnancy is not comprehensive.In particular,the effects of different surgical methods such as hysteroscopic surgery,laparoscopic surgery,and suction curettage on the pregnancy outcome of CSP patients who are pregnant again are lacking.This study aims to understand the effect of different surgical methods on the treatment outcome of CSP patients and the reproductive outcomes to fill the blank in this regard.Materials and methods:A total of 110 patients who were diagnosed as CSP by MRI or ultrasound from 2015 to 2017 in Ningbo Women and Children’s Hospital were collected.Divided into three groups according to different treatment methods,a total of 46 cases in the UAE+suction curettage group,a total of 40 cases in the hysteroscopy operation group,and laparoscopic hysteroscopy combined surgery a total of 24 cases in the group.A retrospective analysis was conducted to compare the patient’s age,times of pregnancy,abortion,delivery,and cesarean section,CSP type,days of menopause,intraoperative blood loss,hospitalization time,hospitalization cost,reproductive outcomes,and placenta at delivery(placenta implantation or adhesion,placenta previa),postpartum hemorrhage,uterine rupture.The data were statistically analyzed using SPSS25.0.Quantitative data in accordance with the normal distribution were analyzed by analysis of variance between more than two groups,and the SNK method was used for comparison between two groups.The quantitative data of non-normal distribution were tested by rank sum test,and the qualitative data was tested byχ~2test.P<0.05 considered the difference to be statistically significant.Results:The hospitalization time in the hysteroscopy group was significantly shorter than that in the UAE+suction curettage group,and the average hospitalization time in the laparoscopic hysteroscopy group was between the other two.There was no statistically significant difference in the average hospital stay between the other two surgical methods.The hospitalization cost of hysteroscopic surgery is significantly lower than the other two surgical methods.There was no significant difference in pregnancy outcome,CSP recurrence rate,and live birth rate among different surgical methods.There is no statistically significant difference in the effects of different surgical methods on the four obstetric complications(placental adhesions or implantation,placenta previa,postpartum hemorrhage,uterine rupture or threatened uterine rupture),but no patients with laparoscopic hysteroscopy group experienced uterine rupture or threatened uterine rupture.Uterine rupture or threatened uterine rupture occurred in other surgical methods.The effect of age on the reproductive outcome is statistically different,suggesting that as the age increases,the miscarriage rate increases.The effect of pregnancy times on the reproductive outcome is statistically different,suggesting that the pregnancy times and cesarean delivery times of miscarriage patients are significantly higher than those of other pregnancy outcomes.And the times of pregnancy and delivery has a statistical difference on the occurrence of obstetric complications,the number of abortions increases,the probability of placenta previa increases,the number of pregnancy and abortions increases,the probability of occurrence of placental implantation or adhesion,postpartum hemorrhage increases,the increased cesarean section increases the probability of uterine rupture.Conclusions:This study found that for type Ⅰ and type Ⅱ CSP,hysteroscopic surgery is significantly better than the other two surgical methods from a socioeconomic perspective,but the indications for surgery must be strictly grasped.Compared with the other two surgical methods,laparoscopic hysteroscopy has an irreplaceable role in the treatment of type Ⅲ CSP.,and for CSP patients with reproductive requirements and a thin muscular layer at the scar,the risk of uterine rupture may be reduced.UAE+suction curettage is a more classic method of treatment for CSP,but the UAE+suction curettage group has a longer hospitalization period.Early detection and early treatment are of great significance for reducing the treatment risk of CSP patients.There were no statistically significant differences in pregnancy outcomes and complications in the three treatment modalities of the enrolled patients in this study.The important factors affecting the reproductive outcome and obstetric complications are the patient’s age and the number of abortions and births.Therefore,childbearing at the right age,reducing the rate of cesarean section and reducing abortion have positive influence to reduce the risk of CSP patients and reduce CSP.