The Value Of Ultrasound-guided Uterine Aspiration In The Treatment Of Gestational Sac Type Cesarean Scar Pregnancy

Objectives: To investigate the effect of gestational sac type cesarean scar pregnancy(CSP)treated by ultrasound-guided uterine aspiration and the relevant factors affecting the clinical outcome.Methods:A retrospective analysis was conducted in 207 cases of gestational sac type CSP patients treated by ultrasound-guided uterine aspiration in the second hospital of Hebei Medical University from January 2016 to December 2018.The gestation age was from 26 to 84 d(47d).There were 85 cases of type ?CSP,117 cases of type ? and 5 cases of type ?.Results:Among the 207 cases,179 cases(86.5%)were successfully treated by uterine aspiration,and the curative rate was 96.5%(82/85)and 82.9%(97/117)in type ? and type ? CSP respectively.28 cases(13.5%)underwent supplementary surgery,including hysteroscopy,or resection of CSP and repairing of the myometrial defects through vaginal,laparoscopic,or abdominal approach.During uterine aspiration,3.4%(7/207)of the patients had a blood loss of ?200ml,and there was no uterine perforation,bladder injury,or uterine artery embolization or hysterectomy to control heavy bleeding.Univariate analysis showed that the gestation age,serum ?-human chorionic gonadotropin(?-HCG)level,the diameter of the pregnancy sac,the myometrium thickness,medical pretreatment,and hemostasis with packs after uterine aspiration were related to supplementary surgical procedure after uterine aspiration.Multivariate Logistic results showed that the diameter of the pregnancy sac(OR 4.652,P=0.004),the myometrium thickness(OR 5.154,P=0.041)and hemostasis with packs after uterine aspiration(OR 3.859,P=0.013)were independent factors for the need of supplementary surgicaltreatment after uterine aspiration.Conclusion:Gestational sac type CSP should be diagnosed and treated earlier,and ultrasound-guided uterine aspiration is a satisfactory first-line treatment with relatively safe and effective outcomes,especially for type ? and ?.When the diameter of the pregnancy sac is >3cm,or the myometrium thickness is?3mm,or hemostasis with packs is needed after uterine aspiration,additional surgical procedure should be taken.