Explore The Clinical Value Of The Hysteroscopic Treatment Of Accurate Range Cesarean Cesarean Scar Pregnancy Ⅱ Type

Objective To evaluate the fuction of hysteroscopy combined with vacuum aspiration in treating limited type Ⅱ cesarean scar pregnancy cases.Methods 45 cases of type Ⅱ cesarean scar pregnancy,admitted between Jun.2018 and Jul.2019,that treated by hysteroscopy combining with vacuum aspiration,are analysed retrospectively.The patients were followed up after operation,the data were summarized and analyzed to discuss the value.Results The main information obtained from the electronic medical record is as follows:(1)gestational age:35 ～ 77d;(2)The maximum diameter of the pregnancy sac attached to the scar: 10 ～ 60mm;(3)Preoperative blood β～HCG level: 7871 ～ 259631 m IU/ m L,mean(64711.2±232271.32)m IU/ml;(4)On the first day after the operation,the blood β～ HCG decreased by more than 50%.CSP after cesarean section can occur in any population of childbearing age,at any time after cesarean section,regardless of the number of previous pregnancies,deliveries,and cesarean sections.Follow-up to obtain information:The duration of postoperative vaginal hemorrhage ranges from 7 to 18 days(mean value 12.74±3.93d).The mean time for β～ HCG recovery to non-pregnancy level ranges from 16 to 37 days(mean value 25.51±6.72d).The mean time of menstruation recovery ranges from 17 to 45 days(mean value 30.42±4.81d).In all 45 cases,no residual tissue of pregnancy is detected by ultrasound taken after menstruation recovery.Meanwhile,4 cases have perioperative hemorrhage over 150 ml.Among the 4 cases,one is pregnant for 11 weeks,with bleeding controlled by subsequent drugs.One case is amenorrhea for 43 days,with two previous cesarean sections,and has transient rapid bleeding during D&C.The rest two cases need number 18 catheter balloon made of disposable rubber packing to control the bleeding,as one has amenorrhea for 63 days with gestational sac60 mm in diameter and β-HCG of 259631 m IU/m L,whereas the other one is amenorrhea for 57 days with two previous cesarean sections,gestational sac 51 mm in diameter and β-HCG of259631 m IU/m L.Conclusion Early diagnosis and treatment is the key to clinical treatment of CSP,which is a serious harmful disease;On the premise of ensuring safety and effectiveness,individual programs were developed according to the severity of the disease,CSP classification,scar thickness,gestational age,fetal sac size,blood HCG level,and patient wishes;The advantages of comparison with the expert consensus combined therapy with UAE,not only reduced patients’ economic burden,also reduced the interention caused by decreased ovarian function,caused by intrauterine adhesions and other side effects.Under the security process,hysteroscopy combined with vacuum aspiration is an effective and valuable therapy in precisely treating type Ⅱ cesarean scar pregnancy cases,Is worth promoting.