Diagnosis And Management Of Middle-late Caesarean Scar Pregnancy

Aim:To explore the predisposing factors, pathogenesis, diagnosis, treatment and prevention of caesarean scar pregnancy.Methods:Review and analyze three years’materials of clinical data of cases which are about the implanting of uterine cesarean in placenta scar from January2009to December2011.20cases of preoperative and postoperative pathological both confirmed that the implanted placenta and implanted area are≧1/2.Results:Five people in the middle pregnancy, accounting for25%,15people in the late pregnancy, accounting for75%and all this20cases are the for the leading of placenta and uterine cesarean section scar place implanted placenta.19person are belong to the one time Cesarean section and one person is belong to the two time cesaream section. Pregnancy times are from1to9times and the age is between26and40. The coincidence rate of Color doppler ultrasound diagnosis is80%and the magnetic resonance imaging diagnosis is91.7%.9cases of color doppler ultrasound in20whose description of the implanting placenta depth are consistent with the description depth of preoperative and postoperative pathological, thus the coincidence rate is45%. There are9cases in12whose description of the depth of placenta accreta is consistent with intraoperative and postoperative pathological description, thus the coincidence rate is75%. There are12cases which accounting for60%apply longitudinal incision in the operation. While6cases of transverse incision which accounting for30%and2cases of change from transverse incision to longitudinal incision which accounting for10%. There are16cases of longitudinal incision of uterus which accounting for80%and4cases of transverse incision of lower uterine segment which accounting for20%.7cases of the implanting placenta which accounting for35%and3cases which invades Serosal layer and baldder which accounting for15%.3cases which penetrate into through Serosal layer and bladder are late pregnancy. The most widely used method of stopping bleeding are mainly tourniquet, bilateral internal iliac artery ligation and the acupressure oppression of the next segment of the occlusion of the abdominal aorta. Three cases of retaining the uterus which accounting for15%and they are all medium-term pregnancy.17cases of hysterectomy or uterus and subtotal resection which accounting for85%. Conclusion:Reducing the incidence of caesarean sections is fundamental to reduce the incidence of placenta accreta in the scar. Early diagnosis and a multidisciplinary team work are essential to improve prognosis and to reduce neonatal and maternal morbidity and mortality. Abdominal longitudinal incision should be adopted regardless of the medium-term pregnancy or late pregnancy, which will help the exposure of the surgical field and surgical operations, if necessary, up to extend the incision to the navel. The uterine incision should be chosen according to the placental site, whether to choose any kind of the uterine incision, we should try to avoid the placenta. If a ferocious bleeding occurs in the caesarean section of placenta implanted in the scar and measures to stop bleeding invalid, it should be decisive to have a hysterectomy or a subtotal hysterectomy surgery, we should attach importance to individual choice of surgical approach.