Clinical Analysis Of 69 Cases Of Cesarean Scar Pregnancy Treated By Vacuum Suction

Objective:To explore the risk factors of using vacuum suction to treat cesarean scar pregnancy(CSP).To explore the conditions of successful treatment of CSP by vacuum suction.Methods:A retrospective study was conducted to analyze the clinical data of 69 patients with CSP who received vacuum suction from January 2013 to June 2016 in the first clinical hospital of Shanxi Medical University.The 69 patients after hospitalization accept vacuum suction under adequate preparation.If intraoperative bleeding is not much,clear villi could be found,and the operation worked smoothly,we classified them into the successful group.Otherwise,if the bleeding much,we stop the bleeding by uterine cavity gauze packing,intramuscular promethazine injection or uterine compression by Foley balloon catheter perfused with physiological saline.If it invalid,we use laparotomy,bilateral uterine artery embolization or iliac artery embolization in the emergency and classify them into the abortive group.Among the successful group,there are still some parts of the cesarean scar pregnancy residues for some people,we call them successful group with residues,and for some people,there are no parts of the cesarean scar pregnancy residues,we call them the successful group without residues.We observed,followed up,summarized the clinical efficacy and outcome of patients in each group and used appropriate statistical soft wares and methods to analyze the clinical data of each group.Then we compared the related factors of the successful group and the abortive group,successful group with residues and the successful group without residues respectively.Combing with clinical practice,we wrote the papers.Results:Of the 69 patients,we find that 57 cases were treated successfully by vacuum suction,and there were 27 cases with residues on the cesarean scar in the successful group.There were 12 cases in the abortive group,among which 7 cases emergency transit uterine artery embolization,again within 24 hours accept vacuum suction,successfully treated,4 cases with emergency trans hepatic cesarean scar site repair,1 case underwent transabdominal hysterectomy after intervention.About 82.6% patients with CSP can be treated successfully after received vacuum suction.The failure rate is 17.4%.The residual rate of scar in the successful group was about 47.4%,and the rate without residual was about 52.6%.The duration of menstrual rejuvenation in CSP patients treated with vacuum suction was 1-3 months.Conclusion:Cesarean scar pregnancy is a rare and dangerous intrauterine ectopic pregnancy and in recent years its incidence is rising.Because of its lack of characteristic clinical manifestations,CSP is easy to be misdiagnosed and missed diagnosis.At home and abroad,there are no clear guidelines for the treatment of CSP,and in clinical practice,the treatment methods of CSP are diversified and tending to a combination therapy.Short menopause time is the key to using vacuum suction to treat CSP,and when menopause time is less than 46.5 days,vacuum suction's positive negative rate could reach 100%,Using vacuum suction to treat CSP can avoid multiple iatrogenic injury such as interventional surgery and surgical and relieve the patients' psychological stress and economic burden.However,we can't use vacuum suction blindly.It can reduce the intraoperative bleeding significantly to only attract uterine cavity not uterine isthmus scar during operation.In addition,we need to reduce the incidence of CSP from the source and ensure early detection,early diagnosis,early treatment and careful clinical treatment,that is,we should do a good job of CSP's three levels preventions before operation.