Discussion Of Pregnancy Termination Method Type ? Cesarean Section Incision Scar Pregnancy

Background and ObjectiveThe rate of cesarean section is always high all of the world.With the second child policy open,pregnant women increase again,the long-term complications gradually emerged,more cesarean scar pregnancy(CSP),uterine rupture,Placenta accreta and even hysterectomy,etc.;Where the CSP is one kind of ectopic pregnancy which refers to the gestational sac implantation in the uterine incision scar.can cause serious maternal complications or even death.Its pathological mechanisms is not entirely clear,the current mechanism is the endometrial and scar tissue between the existence of a fine channel,the embryo through the channel implanted in the myometrium.For the diagnosis and treatment of pregnancy at home and abroad,there is no uniform standard and clinical application guidelines;The Chinese Medical Association of Obstetrics and Gynecology Branch reached a consensus that the treatment of CSP in 2016: early detection,early termination,early removal;Once the CSP diagnosed,it shall recommend termination of pregnancy.If continue pregnancy,can cause placenta previa or placental implantation,and can lead to serious obstetric complications: such as perinatal bleeding,uterine rupture,Hysterectomy,etc.,seriously endanger the life of mother and child.Scar at the diagnosis of pregnancy for the gold standard for pathological examination,but because some of the scar at the pregnancy tissue was not submitted for examination,if the pathological examination to diagnose the scar at the pregnancy,it will reduce the diagnostic rate;and in the clinical diagnosis and treatment process,Preoperative examination is particularly important;the current preoperative diagnosis of scar is mainly rely on color Doppler ultrasound;its imaging features mainly for the following aspects,(1)intrauterine and cervical intravascular no gestational sac;(2)gestational sac part or all located in Uterine incision scar;(3)gestational sac and bladder wall between the uterine muscle thinning,or even missing;(4)embryo with or without fetal buds and fetal heart beat;(5)color Doppler ultrasound CDFI showed gestational sac peripheral high-speed low-resistance blood flow signal;,All the hypertrophy of pregnancy in patients with HCG,but it is not specific,mainly used to evaluate the efficacy and follow-up after surgery.In the course of clinical application,according to the relationship between gestational sac and uterine incision scar is divided into the following types: Type I: refers to the part of the gestational sac implanted in the uterine incision scar,uterine muscle thickness greater than 3mm,CDFI showed gestational sac Low blood flow signal;type II: refers to the part of the gestational sac implantation in the uterine incision scar,uterine muscle thickness less than or equal to 3mm,CDFI showed gestational sac peripheral high-speed low-resistance blood flow signal;type III: Bed in the uterine incision scar,and to the bladder direction convex,uterine cavity and cervical emptiness,uterine myometrium thin or disappear,CDFI showed gestational sac peripheral high-speed low-resistance blood flow signal.Clinical data and methods1.Clinical data retrospective analysis of January 2014 to January 2016,Zhengzhou University First Affiliated Hospital Obstetric treatment of 42 cases of type II scar at the pregnancy patients,according to their different surgical methods are divided into the following three groups: collection of oral mifepristone + 13 cases were treated with ultrasonography as the group A,and 21 cases were treated with bilateral uterine artery embolization and ultrasonography.The patients were divided into two groups: group A(n = 10)and group B(n = 10)Comparative analysis showed that P> 0.05,the difference was not statistically significant,comparable;2.The blood pressure,total hospitalization time and total hospitalization cost were analyzed between the three groups before and after operation.The incidence of postoperative complications of UAE was analyzed and analyzed.The follow-up period(Including menstrual recovery time,compared with preoperative menstrual flow),and comparative analysis.3.Statistical Methods All data were analyzed using SPSS 17.(0),?2 test;measurement data using t test,compared between the two groups using Bonferroni method analysis,P <0.05 for the difference was statistically significant(P <0.05).significance.ResultsCompared with A and C groups,P <0.05,the difference was statistically significant;(2)B group of patients with the least amount of blood loss,and A,C and two,the two groups of patients with the most significant,(P <0.05,the difference was statistically significant;(4)B group of patients with the highest total hospitalization costs,and A(P <0.05),the difference was statistically significant;,C group,P <0.05,the difference was statistically significant;Conclusion:For patients with type II scar pregnancy,whether the combined use of mifepristone before surgery,the postoperative blood ?-HCG decreased no significant difference,but can reduce the risk of intraoperative bleeding;uterine surgery as a new surgical program combined with bilateral uterine artery embolization Surgical approach,because it can significantly reduce intraoperative bleeding,to retain the advantages of fertility,etc.,has been widely used in the clinical process,but with the clinical application of the number of cases,the complications of the situation Gradually in the clinical application process,should be combined with the patient symptoms and signs,patients with family conditions and social factors to determine the comprehensive evaluation of patients to determine the treatment,to avoid clinical application Blind treatment of UAE treatment process,increasing the risk of complications in patients.