The Clinical Value Of Classification Diagnosis And Treatment In Cesarean Scar Pregnancy

Objective:According to ultrasonic images cesarean scar pregnancy(CSP)divided into three types,explore the clinical value of classified diagnosis and treatment in CSP.Methods: Dissecting 228 cases with cesarean scar pregnancy systematicly and retrospectively in hospital of Affilianted Hospital of Qingdao University from 11/2014 to 6/2017,who were divided in to 3 types.Type ? complete gestational sac implanted in the lower segment of uterus(30 cases),Type ? complete gestational sac implanted cesarean scar(170 cases)and Type ? mixed echo(28 cases).The relationship of three types of CSP patients were compared and analyzed between indexes about bleeding risk which include residual muscle layer(<0.2 cm,0.2~0.3 cm and ?0.3 cm),maximum diameter of gestational sac(?3 cm,?5 cm)and blood flow signal around the gestational sac and their therapeutic methods and prognosis.Results:1.Type ?:Uterine curettage was adopted at most(87.7%,26/30cases)and the proportion of curettage guided by B-mode ultrasonography is 53.8%(14/26 cases).2.Type ?: Uterine curettage(56.5%,96/170cases)and operation through vaginal(21.7%,96/170cases)were adopted mostly.The difference of every treatment methods' constituent ratio is statistically significant,the thickness of residual muscle layer thickness less than 0.2cm was compared with the thickness equal and greater than 0.2 cm and the thickness between 0.2cm and 0.3cm;then the difference of every treatment methods' constituent ratio is not statistically significant,the thickness of residual muscle layer thickness between 0.2cm and 0.3cm was compared with the thickness equal and greater than 0.3 cm.With the decrease of the thickness of residual muscle layer,the proportion of curettage is reduced and the proportion of uterine artery embolism(UAE),laparoscopic surgery and laparotomy is increased.The difference of every treatment methods' constituent ratio is statistically significant,the maximum diameter of gestational sac less than 3cm was compared with the diameter equal and greater than 3cm,and the same is true for the diameter less than 5cm with the diameter equal and greater than 5cm.When the residual muscle layer thickness was less than 0.2cm or the diameter of gestational sac was equal and greater than 3cm furthermore there was blood flow signal around the gestational sac,the proportion of curettage and operation through vaginal is reduced and the proportion of UAE and laparotomy is increased.The difference of every treatment methods' constituent ratio is statistically significant,with comparison between there was blood flow signal around the gestational sac and there no blood flow signal.3.Type ?:When the residual muscle layer thickness was less than 0.2cm or the diameter of gestational sac was equal and greater than 3cm,laparotomy and UAE were the main treatment and the difference of every treatment constituent methods' ratio is statistically significant.Conclusion:1.Uterine curettage is appropriate for patients of Type ? found early,but the curettage guided by B-mode ultrasonography is safer and its cure rate is higer.2.Type?is the most common type clinically,patients' treatment methods are closely related to factors include residual muscle layer thickness,maximum diameter of gestational sac,blood flow signal.3.For patients of Type ?,most of the patients showed abundant blood flow signals around the gestational sac or mass,with a larger diameter.The risk of bleeding is higher,so the treatment needs to be more cautious.4.Classification diagnosis and treatment of CSP by ultrasound is convenient for preoperative estimate of surgery risk and then choosing the appropriate treatment methods.