| Objective: The aim of the study was to discuss the clinical manifestations,diagnosis, treatment and prognosis of caesarean scar pregnancy.Methods: A retrospective study of27patients diagnosed with caesarean scarpregnancy between2007-2013at the First Affiliated Hospital of the Dalian MedicalUniversity was analyzed, including clinical features, diagnosis, treatment and prognosis.Results:1. Clinical features: To these27patients, the mean age of caesarean scarpregnancy at the time of diagnosis was33.33±4.26years old, the number of pregnancieswas2~7times,3of the27patients experienced twice cesarean section, while the othersonly once. The interval between the current pregnancy and prior caesarean sectionranged from1to13years, the mean time was6.00（6.64）years. There were15cases inthe27patients emerging vaginal irregular bleeding symptom,7cases having no clinicalsymptoms,3cases had received suction curettage at their first visit to other hospitalsbecause of misdiagnosing uterine pregnancy,1was misdiagnosed as cervical pregnancy.4cases of cervical were significantly enlargement, of which one case’s cervix changesto purple blue;1case with cervical external expansion. All of27patients showed noobvious tissue material in the cervix os.5cases with clinic gynecological examinationshowed no abnormalities.2. Diagnosis:4patients with mild anemia on admission (hemoglobin between102~107g/L),1patient with moderate anemia (hemoglobin80g/L).A baselineserumβ-human chorionic gonadotropin (β-hCG) concentration were determined at thetime of hospitalization, of which the average level was9670.00（24454.00）mIU/ml(range326.00~136991.00mIU/ml). Transvaginal ultrasound of22patients showsgestational sac, gestational cardiac activity was seen in8of these patients; CSP masswere seen on transvaginal ultrasound in the others；the gestational tissue of11patients is located outside the uterine cavity, while the remaining patients inside the uterin cavity.Abnormal blood flow signals were seen around gestational sac of26patients, including16cases of blood flow to prompt.3cases ultrasound tip intracervical mouth expansion,1case prompted cervical os dilation.3. Treatment:7(7/11)patients were successfully treated by conservativetreatment,4cases diverted suction curettage, one case of bilateral uterine arteryembolization.11patients were successfully treated by suction curettage withtransabdominal ultrasound guidance, while1case of bilateral uterine arteryembolization diverted; operative hysteroscopy for3cases, bilateral uterine arteryembolization for5case（s3cases as a preventive treatment）, laparotomy for1case weresuccessfully carried out.28subjects were successfully treated with fertility preserved.4. Prognosis: The mean time until normalization of serum β-HCG（<10mIU/ml）was34.04±16.71days; the mean time until normal menstruation was29.91±21.03days;no recurrent CSP was reported.11cases (11/23) of previous cesarean section was not inlabor, including cesarean section breech in3cases.Conclusion:1. The clinical symptoms of CSP are not typical, the diagnosis was confirmed withcolor doppler ultrasonography.2. Be full attention of CSP before the termination of pregnancy can significantlyreduce the risks of severe haemorrhage and other complications that occur duringpregnancy termination. Pretreatment as well as individualized treatment plan canacquire a good therapeutic effect.3. When massive hemorrhage of CSP encountered, uterine artery embolization isrecommended as the first choice; UAE treantment of CSP used as prevention ofhemorrhage should be reconsidered. |
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