Subsequent Pregnancy Outcome After Treatment Of A Previous Cesarean Scar Pregnancy

Objective:To investigate the pregnancy outcomes and complications of pregnant women after cesarean scar pregnancy(CSP)treatment,and to understand the effect of uterine artery embolization(UAE)on ovarian function and re-pregnancy.Methods:A retrospective analysis of 115 patients who were diagnosed with CSP and met the inclusion criteria in the obstetrics family planning department of our hospital from January 2011 to July 2016.The re-pregnancy status was analyzed.According to whether uterine artery embolization(UAE)was performed during the last CSP treatment,the patients were divided into intervention group and non-intervention group to analyze the effect of UAE on the patient's re-pregnancy.Results:All patients were followed up for more than 2 years from the previous CSP.38 patients were pregnant again and 6 patients had recurrent CSP(RCSP).The incidence of this complication was 15.8%(6/38).All patients were terminated by cesarean section of the lower uterus,and 20 live babies were delivered.Perinatal complications and their incidence were placental adhesion,placental implantation(4.35%,1/23),postpartum hemorrhage.(4.35%,1/23),incomplete uterine rupture(4.35%,1/23),premature rupture of fetal membranes(8.70%,2/23).Comparing the data of second pregnancy betweeninterventional group and non-interventional group,it was found that there was no significant difference between the two groups(average P > 0.05)in the intrauterine pregnancy rate within 0.5,1 and 2 years after treatment,the intrauterine pregnancy rate within 2 years and the incidence of secondary infertility.Conclusion:Patients with re-pregnancy after CSP treatment should be alert to complications such as RCSP,perinatal uterine rupture,placenta implantation,and major bleeding.It is not recommended to routinely perform scar repair in patients with CSP history.In order to reduce the incidence of RCSP,contraception should be strictly applied to those who do not wish to have another pregnancy.Re-pregnancy patients should be regularly examined during pregnancy in a comprehensive hospital which has the ability to rescue high-risk maternal women.If there is no medical indication for early termination of pregnancy,pregnancy can be delivered to full-term elective cesarean delivery.In addition,this study found that UAE may have no significant effect on ovarian function and fertility in patients.