| Objective:To investigate the pathogenesis,clinical characteristics,diagnosis and the effect of different treatment methods of three kinds ofcesarean incision complications-cesarean scar pregnancy, incisiondiverticulum and incomplete healing of incision, in order to provide theclinical basis for the early diagnosis and correct treatment.Methods: Collected the cases of cesarean scar pregnangcy admissed inthe second hospital of Hebei Medical University from January2008to July2012,cases of incision diverticulum and incomplete healing from2003to July2012,retrospectively analyzed medical history and clinical data including:age,parity, number of cesarean section, the reasons for cesarean, time interval ofthe last cesarean section to the onset, menopause, vaginal bleeding andabdominal pain, menstrual status, gynecological ultrasound results, HCG levelof blood, treatment, length of hospital stay, the data was statistically analyzedand we followed-up the postoperative menstrual changes in patients withincision diverticulum and incomplete incision healing.Results: Our hospital in recent10years totally treated11patients withincision diverticulum,43patients with incomplete uterine incision healing; and126cases of cesarean scar pregnancy from2008to July2012, accounted for6.02%of all ectopic pregnancy during this period.The number of cesarean scar pregnancy was on the rise, total9casestreated in2008,15patients in2009,22patients in2010,43cases in2011,andwe got37cases in2012between January and the end of July, type1ofcesarean scar pregnancy increase gradually.61.11%of the patients showed asmall amount of vaginal irregular bleeding,and spontaneous bleedinggenerally began43.2days after menopause,only14.3%patients had abdominal pain, and only11.11%of patients were gynecologic examined lower uplift ormass with tenderness.13patients did not have a blood test for HCG, the otherpatients with an average of8292±30423.46IU/L.126cases were diagnosedby ultrasound in our hospital, including3cases with placenta increta, themisdiagnosis rate of outer courts was30.16%.41patients took medicineconservative treatment, and the success rate was90.24%,2patients underwentdirect curettage,18cases were curettaged with ultrasound guided and nointraoperative bleeding,38patients underwent drugs combined with uterinecurettage,and the success rate was92.11%,16patients were treated byoperation, the success rate was93.75%,3cases with large hemorrhage wasreceived uterine artery angiography and embolization, then curettaged3dayslater,which had less intraoperative bleeding,and the length of hospital stay wasshortest compaired with others.Among the11cases with incision diverticulum only1case hadsymptoms of infection after cesarean section,4cases (36.4%), characterizedby dripping vaginal bleeding after menstruation was clean,3cases (27.3%)showed menstrual period extended by10to18days, the other4cases (36.4%)had no typical symptoms,8of11patients had received surgical treatment,2cases of laparoscopic repair,4cases of laparotomy,1case of hysteroscopicrepair,1cases of hysteroscopic embryo remove. Postoperative follow-up:1case was lost, only5cases’symptoms were improved, and among them2cases recurrenced in the six months to two years later, another2cases’symptoms did not improve, moreover repeated ultrasounds found the defectsstill existed, but the areas were decreased,1case of untreated had alreadynatural pregnanced.There were44.19%(19/43) patients with anemia in the43cases who hadpoor healing of uterine incision,34.89%(15/43) chose cesarean section due tothe prolonged labor, amniotic fluid contamination in up to11.63%(5/43),premature rupture of membranes occurred in9.30%(4/43)patients, placentalabruption and gestational hypertension rate were both6.97%(3/43),fever casesaccounted for46.51%(20/43), they all got high temperature repeatedly for more than ten days,70%of them (14/20) with vaginal bleeding or purulentsex secretion,19%(7/43) patients showed only persistent abdominal pain orvaginal bleeding,36cases (83.7%) toke the non-surgical treatment,7cases(16.3%)were treated with surgery, including5cases with pelvic hematoma,2patients came with repeated vaginal bleeding, which were treated with uterineartery angiography and embolization, but1cases sill emerged bleeding andunderwent laparotomy with uterine incision repair eventually.We followed-up33cases,among them4patients discovered incision diverticulum.Conclusion:1The incidence of cesarean scar pregnancy is increasing, medical andartificial abortion without direct diagnosis may lead to heavy bleeding,shockand other dangerous situations. Different measures should be given todifferent patients according to the different situations, combination treatmentand ultrasound guided curettage are safer than simple drug treatment, for thecases with big mass or the embry is obvious convex to the musclelayer,surgical operation to resecting of the lesion and repair scar is the bestchiose.2Patients with incision diverticulum manifested as the drippingbleeding, followed by prolonged menstrual cycle, but some can be no obvioussymptoms,gynecological ultrasound and hysteroscopy are main auxiliarymethods in the diagnosis of incision diverticulum,the clinical treatment is stilla problem,especially for surgery and we need more polycentric studies toprove.3The common risk factors of poor healed incision are anemia andprolonged labor,and it could developed into incision diverticulum,patientsalmostly appear fever in the postoperation firstly, and fever with vaginalbleeding or purulent sex secretion is the main clinical symptoms,uterinetenderness is obvious in patients with pelvic complication, and conservativetreatment effect is good for the minor symptoms’, however, surgical treatmentshould be taken as soon as possible for patients with heavy bleeding andserious infection. |
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