The Diagnosis And Treatment Of Cesarean Scar Pregnancy

BACKGROUD A cesarean scar pregnancy( CSP) is a gestational sac located in the previous cesarean delivery scar, and it is a special type of ectopic pregnancy which is rare and dangerous. As the increasing rate of cesarean section, the morbidity of CSP is increasing every year. In China, a policy that allowing couples to have two children has established recently. Thus an increasing number of women of cesarean section histories intent to bear a baby once again so that the morbidity of CSP will further increase. It is considered a life-threatening condition because of the high risk of uncontrolled hemorrhage and uterine rupture, which might lead to a hysterectomy, with catastrophic consequences for women’s fertility potential and health. Diagnosis early and making a reasonable choice of treatment seems critical to conserve the women’s reproductive future.According to the current clinical problems and research status of CSP, we initiated a study in two areas, including:(1) Investigating the clinical value and validity of treating cesarean scar pregnancy(CSP) with 3methods.(2) Discussion the indications and clinical value of different types of cesarean scar pregnancy treating by hysteroscopy.Objective: To investigate the clinical value and validity of treating cesarean scar pregnancy(CSP) with 3 methods. Methods: We retrospectively analyzed the clinical data of 72 patients with CSP in the first Affiliated Hospital of Chongqing Medical University from January2014 to December 2015. Patients were divided into three groups depending on different treatment methods :Group A(treated with hysteroscopy,n=47), Group B(treated with MTX and hysteroscopy,n=14), Group C(treated with surgery,n=11). Results:(1)Among the 3groups, the patients’ age, the gestational age, the β-h CG level, the gestational sac diameter were no statistically significant. The thickness of myometrium over gestational sac in Group C was the thinnest between the three groups, and the difference existed statistically significant(P=0.003,P=0.016).(2)Comparing with Group A and Group B, the operative blood loss in Group C was the most, and the difference was statistically significant(P=0.001,P=0.007).Comparing with Group B and Group C, the hospitalization days in Group A was the shortest, and the difference was statistically significant(P=0.000,P=0.000).The time of β-h CG to normal and the time of menstruation recovery were no significant difference among the 3 groups. Conclusions:(1)In recent years, China has established a policy that allowing couples to have two children. Consequently, an increasing number of women who had received cesarean section come across CSP during their following pregnancies.And that will lead to an increasing morbidity of CSP.(2)Treating CSP by hysteroscopy(with or without MTX) has less bleeding, rapid postoperative recovery, shorter hospital stay compared to the traditional surgery.Objective: Discussion the indications and clinical value of different types of cesarean scar pregnancy treating by hysteroscopy. Methods: A retrospective analysis was made on 62 patients treated with hysteroscopy that were divided into two groups, for example,Group A( type I CSP, n =45), Group B(type Ⅱ CSP, n = 17). Results :In the two groups, the gestational age, number of gravida and parity, number of cesarean section,preoperative β-h CG level were no statistically significant. The thickness of myometrium over gestational sac of type Ⅱ CSP was thinner than type I CSP, gestational sac diameter of type Ⅱ CSP was bigger than type I CSP,and the difference existed statistically significant( P=0.000,P=0.011) The operative blood loss,hospitalization days of type I CSP were less than type II CSP, and the difference existed statistically significant.(P=0.021,P=0.049).Conclusions:(1) Suction and curettage under hysteroscopy guidance in treatment of type I CSP is less blood loss, shorter hospitalization time, quick recovery.We recommend it as the preferred alternative in treatment of type I CSP.(2) Operative excision of CSP may be the better choice in treatment of exogenous CSP for those women,failure in the primary treatment or non-surgical treatment,that hope to bear a baby once again.