Clinical Analysis Of23Cases Of Cesarean Scar Pregnancy

Objective: To discusses the early clinical manifestation, diagnosis and treatment ofCesarean scar pregnancy.Methods: The clinical data of23patients with CSP who were treated in the FirstClinical Hospital of Dalian Medical University from August2010to March2014wereanalyzed retrospectively. Including age of onset, gestational age, the symptomaticgestational age, the early manifestation, the incidence of cesarean section from the lasttime interval, the past history of uterine cavity operation, ultrasound manifestations,level of human chorionic gonadotropin, progesterone levels, clinical type, treatmentand result.Results:The average age of the23patients was32.2±3.8years(25~39), the averagegestational age was47.7±7.6days (37~62)。The time interval between the last cesareansection and the CSP was about14months to13years in the series, the average was75.6±47.9months, among them, interval≤2years were4patients,>2years and <3years was0patient,3-5years were7patients,6-10years were8patients,>10years were4patients.20patients had one cesarean section,2had two cesarean section,1had3cesarean scar pregnancy. In the series,17patients had at lest one uterine operationhistory, the most had7uterine operation histories, only6patients did not have anyuterine operation history. All of these patients had regular menstruation,21hadamenorrhea before refer to hospital,2patients didn’t have amenorrhea, these two hadvaginal bleeding approximately20days after last menstrual period. The averagesymptomatic gestational age was37.9±9.9days(20~57). The main clinical manifestation was the vaginal bleeding after menopause, the were12patientsmanifested vaginal bleeding, among them, only two patients’ vaginal bleeding wassudden and massive, whom were misdiagnosed at the first visit in other hospital,4patients accompanied mild abdominal pain.1patient just had mild abdominal pain, andthe last10patients neither manifested vaginal bleeding nor abdominal pain. The bloodβ-HCG on admission in hospital was326.5~128480mIU/ml, average was28172.7±37798.2mIU/ml.9patients had progesterone record, the blood progesteronewas5.44~33.74ng/ml on admission, average was18.02±9.7ng/ml, among them,7patients’progesterone <25ng/ml,2>25ng/ml, these two were type I CSP with primitiveheart tube pulse. All the patients were diagnosed with transvaginal Color Dopplerultrasound for clinical diagnosis. In the series,19patients were diagnosed accurately atthe first visit,1was diagnosed in other hospital.4patients were misdiagnosed, all ofthese4patients were misdiagnosed in other hospital, among them,3weremisdiagnosed as intrauterine pregnancy,1was misdiagnosed as cervical pregnancy. Inthe series, the treatment could summarized as5therapies.①Chemotherapy protocol,11patients were treated.②Chemotherapy followed by curettage under ultrasonicmonitoring,5patients were treated.③Chemotherapy followed by hysteroscopicresection,3patients were treated.④UAE followed by curettage under ultrasonicmonitoring,3were treated.⑤1via laparotomy to resect the scar with gestational tissueand wound repair to preserve the uterus.23patients were successfully treated byconservative therapy, no one with hysterectomy, all keep fertility. The hospitalizationtime was7-77days, average22.8±15.8days. The hospitalization expense was3301.69~15396.48renminbi(RMB), average8115.08±4278.10RMB.Conclusion:1.There is no specific clinical manifestations in the early stage of CSP, it is easy tobe misdiagnosed, the misdiagnosis rate of CSP in the basic hospital is a high.2.Artificial abortion, Dilatation and curettage are risk factors of CSP, multiplecesarean dilivery isn’t the risk factors of CSP.3.Transvaginal Color doppler ultrasound is the major imaging diagnostic methods. For the pregnant women with cesarean section history, we should take ultrasonicinspection to exclude CSP as early as we can.4.For the pregnant women with cesarean section history, we suggest testprogesterone as a routine examination.5.The treatment should individuation. MTX or UAE followed by curettage underultrasonic monitoring are safety and feasible CSP therapies.