Clinical Analysis Of57Cases Of Cesarean Scar Pregnancy

Objective:Cesarean scar pregnancy (CSP) is the embryo implantation in a previous cesarean scar. It is often misdiagnosed as intrauterine pregnancy to operate artificial abortion or curettage which cause fatal bleeding.CSP is a complication of the cesarean section and it is not a common disease in Obstetrics and Gynecology. It has been gradually recognized at present.CSP is a type of ectopic gestation associated with a high risk of serious complications,such as uterine rupture and uncontrollable hemorrhage, if it is not early diagnosed and treated. A delay in diagnosis and/or treatment can lead to uterine rupture, major haemorrhage, hysterectomy and serious maternal morbidity. Early diagnosis can offer treatment options of avoiding uterine rupture and haemorrhage, thus preserving the uterus and future fertility. The aim of this study was to discuss the clinical features and to provide clinical basis for the early diagnosis and treatment of CSP.Methods:Fifty-seven CSP cases from January2007to December2011in Jiaxing Maternity and Child Health Care Hospital were included in the present study and their data were analysed, including the age of the patients, the frequency of pregnancy bearing, the interval from the last cesarean delivery to diagnosis, clinical manifestations, diagnosis, the process and the outcome of different treatments.Results:The mean age of the57patients was32.8years. They all had a history of cesarean section.Three women had two previous cesarean sections; two women had three previous cesarean sections and the others had only once.The interval between cesarean section and admission ranged from0.67years to19years.Twenty-three cases in the fifty-seven patients were painless irregular vaginal bleeding as the main symptom.Two cases showed abdominal pain.Twelve cases were misdiagnosed to operate artificial abortion or curettage.Twenty cases had non-clinical performance characteristics which were diagnosed by ultrasound examination. Six Patients were treated with MTX intramuscular injection; ten patients were treated with trichosanthin(TCS)intramuscular; twenty-three patients were treated with TCS combined with local MTX; eleven patients were treated with TCS combined hysteroscopic treatment; four patients were treated with TCS plus curettage; three cases with massive vaginal bleeding in emergency were given ultrasound-guided curettage.They were all cured.Conclusions:1) CSP can cause heavy vaginal bleeding and lead to hemorrhagic shock and hysterectomy,so it is a very dangerous type of pregnancy.Early diagnosis and correctly handle of the disease is essential. 2) Color doppler ultrasonography is principal diagnosis, especially the transvaginal ultrasound.3) For stable CSP patients, we can choose conservative treatment. Trichosanthin is superior to MTX with no β-HCG limitation, rapid onset, faster drop in β-HCG level.Trichosanthin and local MTX have better effects which can play the advantages of two kinds of drugs. Hysteroscopy after trichosanthin is regarded as the effective management to cesarean scar pregnancy, because of less blood loss, faster drop in β-HCG level and quicker mass absorption and preserving the reproductive capacity.