| Objective:The aim of the study was to discuss the general clinical data, treatment and prognosis of of the 186 cases of Cesarean Scar pregnancy, to Study the general clinical characteristics of uterine scar pregnancy and the clinical efficacy of four kinds of treatments。Methods:Collected 194 cases of CSP patient from 2012.1-2015.12 at the First Affiliated Hospital of the Chongqing Medical University and Second Affiliated Hospital of the Chongqing Medical University,to analyze the clinical data of the CSP patients,Including the age of the patients,pregnant time, number of induced abortion, cesarean delivery times,clinical manifestations, imaging findings, diagnosis and treatment.SPSS19.0 version statistical software analysis on data processing, the normal distribution of the measurement data of mean(x±s) said, P < 0.05 for the difference was statistically significant, P < 0.01 for significant differences.Results:1. General information: patient age 19-46, the average(34.5 ± 6.8)years of age, number of cesarean section 1-3 times, the average(1.35 ±0.25) times, 109 cases of cesarean section 1 time,82 cases of cesarean section 2 times 2 cases of cesarean section 3 times.Abortion times 0-9times, average(3.46± 2.52) times,there are 158 case of CSP patients had 2times and 2 times higher abortion. the time interval from the last cesarean delivery was about 3 months to 15 years, the average(4.46±2.48) years.Of the cases,there was 29 cases was misdiagnosed, accounting for15.6%.Rhythm 55 cases, intrauterine device of contraception in 2 cases,condoms for birth control 18 cases, 23 cases of oral contraceptive birth control, but there are still 88 patients without taking birth control.2.Clinical features and The misdiagnosis analysis: patients often have postmenopausal vaginal bleeding or(and) abdominal pain, 68 cases only had irregular vaginal bleeding after menopause.only 4 patients appeared Abdomen ache after menopause; About 49 patients appeared postmenopausal vaginal bleeding and abdominal pain; however, 65 patients neither had the vaginal bleeding,nor abdominal pain symptoms, accounts for about 35 %.In this study, a total of 29 cases of the outer court, accounting for15.6% of the total. Of 2012-2015, their annual misdiagnosis rate was37.5%, 19.4%, 11.5%, 8.2%, so the misdiagnosis rate is on the decline every year. 18 cases were diagnosed as threatened abortion for the first time in the outer court, 9 cases were diagnosed as intrauterine pregnancy in the outer court for the first time, 2 cases of diagnosis of cervical pregnancy forthe first time in the outer court.3. Treatment: a total of 194 patients, of 37 cases of methotrexate therapy, 25 cases of successful treatment, others treatment failure;55patients given drugs(mifepristone and misoprostol) followed by ultrasound—guided suction curettage,50 cases of successful treatment, 5cases failure;30 regular uterine scar resection of the lesions + repair, 29 cases of success, including 1 case of total hysterectomy because of sertoli cell infiltration is widespread and bleeding 2000 ml, 2 cases of bilateral ligation of fallopian tubes at the same time line;64 cases of patients under hysteroscopy surgery curettage, 60 cases of successful treatment, 4 cases of failure。Conclusion:1. Many people(twice or higher), short distance between cesarean delivery last time(5 years or less) of women more likely to occur CSP when pregnancy again, effective birth control measures should be taken to reduce cesarean section of an unplanned pregnancy.2. With the increase of medical staff understanding of the disease and advanced ultrasound instrument, the misdiagnosis rate CSP declined year by year.3. The clinical manifestation of CSP lack of specificity, there are some patients without obvious clinical symptoms, easy misdiagnosis or missed diagnosis, therefore, has a history of cesarean section of pregnancy allneeds to consider the possibility of uterine scar pregnancy, Ultrasonic doppler examination is the main auxiliary examination CSP4. Combining with the study drug therapy, drugs combined ultrasound—guided suction curettage, drug combined hysteroscopic treatment, uterine scar resection of the lesions + repair are effective treatment of uterine scar pregnancy, should be individualized treatment,comprehensive patients can obtain good curative effect and preserve reproductive function. |
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