| Objective : A retrospective study of the factors associated with cesarean scar pregnancy,to provide theoretical basis for the prevention of ectopic pregnancy,and discuss the advantages and disadvantages and pregnancy outcomes different treatment for cesarean scar pregnancy,to look forward to provide theory support for the clinical treatment of cesarean scar pregnancy.Methods:Seek out all inpatients in hospital attached to Ningxia Medical University from January in 2008 to February in 2016 because of cesarean scar pregnancy,all patients with a total of 100 people,which treatment she had grouped her team: conservative treatment ? uterine curettage under ultrasound or hysteroscopy ? uterine curettage after embolization.Select 100 patients of normal pregnancy in the same period but has a history of cesarean section as a control group.All the date were deal with SPSS 19.0,measurement data is expressed the mean and standard deviation,count data with the statistic analysis or chi-square test,to find out related factors,follow-up the patients' hospitalization days?the cost and the time of HCG down to normal,to seek out the best treatment.Find out the patients who have the requirement of reproduction,follow-up their pregnancy-related situations with their sex life without contraceptive in one year,it including normal pregnancy?ectopic re-pregnancy and sterility.Result:1.High incidence of age of Cesarean scar pregnancy between 30-39 years old;2.Results of single factor analysis: the differences of induced abortion history?placenta previa?artificial stripping the placenta?the part of the presentation of previous cesarean delivery?a history of pelvic inflammatory and abdnominal operation were statistically significant(p<0.05),the differences of nation?smoking?drinking?menstrual disorders?uterine fibroids?endometrial polyps?placental abruption?the number of cesarean delivery?from the previous cesarean delivery time?history of ectopic pregnancy ? ovarian tumor ? assisted reproductive technology ? intrauterine device and oral contraceptives were no significant(p>0.05).3.Results of muti-factor analysis: a history of induced abortion ?the part of the presentation of previous cesarean delivery ?placenta previa?artificial stripping the placenta are the risk factors that exsit independently,their OR value are 4.953?3.257?2.826?2.729.4.The blood HCG before treatment in conservative treatment?uterine curettage under ultrasound or hysteroscopy ? uterine curettage after embolization are 11891.47 ± 8164.16MIU/ml ? 29150.09 ± 9953.03MIU/ml ? 32986.72 ±10987.21MIU/ml,F=37.848,P<0.05,agree there are differences between three groups,pairwise comparison,conside the HCG before treatment with conservative treatment are lower than both uterine curettage under ultrasound or hysteroscopy and uterine curettage after embolization,there's no significant different between uterine curettage under ultrasound or hysteroscopy and uterine curettage after embolization.5.Their focal diameter before treatment and focal from uterine serous layer distance in each groups have no significant differences(p>0.05).6.Their length of day in each groups have no significant differences(p>0.05).7.Cost: the average cost is 4191.80±428.14 yuan by conservative treatment,7363.2±1522.46 yuan by uterine curettage under ultrasound or hysteroscopy,12930.06±1172.72 yuan by uterine curettage after embolization,F=297.88,P<0.05,agree there are differences between three groups,pairwise comparison,conside cost have difference in any two groups.8.The time of HCG down to normal in conservative treatment?uterine curettage under ultrasound or hysteroscopy?uterine curettage after embolization are 29.40±5.75 day?21.57±8.28 day?23.00±4.04 day,F=15.711,P<0.05 agree there are differences between three groups,pairwise comparison,conside the time of HCG down to normal with conservative treatment are longer than both both uterine curettage under ultrasound or hysteroscopy and uterine curettage after embolization,there's no significant different between uterine curettage under ultrasound or hysteroscopy and uterine curettage after embolization.9.The pregnant rate in conservative treatment?uterine curettage under ultrasound or hysteroscopy and uterine curettage after embolization are 70.59%?40.91%?70.00%respectly;and with no significant differences(p>0.05);the ectopic re-pregnancy rate are 11.76%?4.55%?20.00% respectly;and with no significant differences(p>0.05);the sterility rate are 17.65%?54.55%?10.00% respectly,the rate in uterine curettage under ultrasound or hysteroscopy group are higher than both conservative treatment and uterine curettage after embolization(p<0.05).Conclusion:1.High incidence of age of cesarean scar pregnancy between 30-39 years old,should think of it when acute abdominal pain patients with a history of cesarean.2.Cesarean scar pregnancy is related to induced abortion history?placenta previa?artificial stripping the placenta?the part of the presentation of previous cesarean delivery?a history of pelvic inflammatory and abdnominal operation.3.Conservative treatment have the higher cost performance in the treatment of cesarean scar pregnancy.4.Uterine curettage after embolization are fit with the patients who have the requirement of reproduction ?higher HCG and severe disease. |
PDF Full Text Request