Analysis Of 291 Cases Of Gestational Sac Type Cesarean Scar Pregnancy Treated With Dilatation And Curettage Under Ultrasound Guidance

Objectives: Ultrasound-guided dilatation and curettage(D&C)is one of the most commonly used surgical methods for cesarean scar pregnancy(CSP).It has the advantages of simplicity,low cost,little damage and quick recovery.The present study sought to investigate the predictors of unsuccessful ultrasound-guided D&C and the factors associated with D&C followed by uterine artery embolization due to uncontrolled hemorrhage through the different clintical results of 291 cases of gestational sac type cesarean scar pregnancy.Methods:1 Retrospective analysis was conducted in 291 gestational sac type CSP patients undergoing ultrasound-guided D&C under the supervision of gynecological department of the second hospital of Hebei Medical University from July 2006 to July 2016.2 Failure was defined as ultrasound-guided D&C followed by more treatments due to hemorrhage.Without any more treatments was successful group of ultrasound-guided D&C.The unsucessful group of ultrasound-guided D&C was divided into two groups,faliure was defined as D&C followed by uterine artery embolization due to uncontrolled hemorrhage.3 Chi-square test,Fisher exact test and Logistic regression analysis were used to investigate the predictors of unsuccessful ultrasound-guided D&C and the risk factors associated with uterine artery embolization due to uncontrolled hemorrhage.Results:1 84.2%(245/291)of gestational sac type CSP patients treated with dilatation and curettage under ultrasound guidance were successful.Thefailure rate was 15.8%(46/291).The rate of patients treated with uterine artery embolization to control hemorrhage,following scar dissection and uterine scar repair was 28.3%(13/46).2 Between the successful ultrasound-guided D&C group and the unsuccessful ultrasound-guided D&C group,the results of the statistical analysis showed that higher preoperative serum HCG level,heart tube beat,longer crown-rump length,the maximum diameter of gestational sac(≥3cm),ultrasound type Ⅲ,the thickness of myometrium(≤3mm)and more abundant blood flow were the statistically significant variables associated with unsuccessful ultrasound-guided D&C(P<0.05).Logistic regression model was constructed for the statistically significant variables,eventually,the risk factors associated with the unsuccessful ultrasound-guided D&C group were ultrasound type(OR 7.773,95%CI3.038-19.885),crown-rump length(OR 5.561,95%CI 2.974-10.400),the grade of blood flow(OR 2.420,95%CI 1.400-4.183)and preoperative serum HCG level(OR 1.914,95%CI 1.113-3.293).3 The results of the statistical analysis showed that preoperative serum HCG level(>30000m IU/m L),crown-rump length(>14mm)and the more abundant blood flow were the statistically significant variables associated with uterine arterial embolization due to uncontrolled hemorrhage(P<0.05).Logistic regression model was used to construct the multivariate regression analysis.The results showed that the grade of blood flow(OR19.738,95%CI 2.596-150.058)was the risk factor associated with uterine arterial embolization due to uncontrolled hemorrhage.Conclusions:1 Ultrasound-guided dilatation and curettage(D&C)was suiltable for the gestational sac type CSP(ultrasound typeⅠ)patients.2 For the gestational sac type CSP patients with ultrasound type Ⅲ,longer crown-rump length,more abundant blood flow,higher preoperative blood HCG level,ultrasound-guided D&C was more easily failed.3 Uterine artery embolization was suiltable for the hemorrhage of thegestational sac type CSP patients with more abundant blood flow in the unsuccessful ultrasound-guided D&C group.