Evaluate The Effect Of Suction Curettage In The Treatment Of Cesarean Scar Pregnancy(CSP) And The Method Of Hemostasis In Suction Curettage

Objective :To investigate the clinical treatment of Cesarean car pregnancy(CSP).To evaluate the clinical effect in treatment of CSP with suction curettage under ultrasound and Methotrexate(MTX)pretreatment combined with suction curettage under ultrasound.To discuss emergency treatment of hemorrhage during sucting curettage.Method : 66 patients who were diagnosed as CSP I and a part of CSP II(whose scar muscle thickness no less than 2mm)in Rizhao Women and Children's Hospital from Jun.2016 to Dec.2018 were studied.The patients were randomly divided into two groups:33cases named direct suction group were treated with suction by ultrasound guidance;33cases named pretreatment group were treated with Methotrexate before suction by ultrasound guidance.25 patients happened acute vaginal hemorrhage during suction,catheter balloon or gauze packing uterine was used to stop bleeding.Results:1.All patients had been cleared the embryonic tissue successfully,no hysterectomy event occurred.2.Of the 33 cases in the direct suction group,13 patients happened acute bleeding during operation were treated with catheter balloon or gauze filling uterine,2 patients happened msssive haemorrhage and were forced to turn to other surgical treatment;Of the33 cases in the pretreatment group,12 cases happened acute bleeding during operation were also treated with catheter balloon or gauze filling uterine,2 patients happened msssive haemorrhage and were forced to turn to other surgical treatment.The two groups had a same success rate 93.94%;The mean amount blood loss of the two groups was227.75±148.09 ml and 192.08±105.62 ml respectively.The bleeding rate was 39.40% and36.36% respectively.There was no significant difference between the two groups(P>0.05).3.The cost of the two groups of patients was(2618.30±1789.06)yuan and(5296.27±2880.38)yuan respectively.The cost in the direct suction group was obviously less than that in the pretreatment group.The difference was statistically significant(P<0.05).The hospital stay was obviously longer in the pretreatment group(8.61±2.62days)compared with the direct suction group(4.18±1.33 days).The difference was statistically significant(P<0.05).4.Twenty-one patients happened acute bleeding,and 11 cases accepted a catheter balloon to the uterus,10 cases accepted a few gauze pieces into the uterus.The amount of bleeding in the balloon group and was 136.82±39.70 ml and the gauze group191.50±66.08 ml respectively.There was no significant difference between the two groups(P>0.05).The time spent on filling a catheter balloon into uterine during suction was11.27±3.07 minutes and gauze 17.80±3.97 minutes respectively.The difference was statistically significant(P<0.05).Conclusion:1.Suction curettage under ultrasound could be used as a first-line treatment for CSP in primary hospitals.It had the advantage of less cost and short hospital stay.2.Pretreatment with Methotrexate(MTX)combined with suction curettage under ultrasound to treat CSP did not significantly reduce bleeding,but prolonged hospital stay.3.We had a Foley catheter or gauze into the cervix to achieve hemostasis during suction curettage when acute bleeding occured.Both were effective in reducing bleeding.But inserting a catheter balloon to the uterus was easier and faster in bleeding decrease than gauze.