Risk Factors And Clinical Outcomes Of Recurrent Cesarean Scar Pregnancy

Objective By analyzing the clinical outcome of the first CSP,the aim of study is to explor e the risk factors of recurrent cesarean scar pregnancy and reduce the incidence of RCSP.Methods A series of cases of cesarean scar pregnancy admitted to Dalian Maternal and Child Health Hospital from January 2014 to December 2019 were retrospectively anal yzed.The electronic case database was used to query the patients with "uterine scar preg nancy".The patients diagnosed with uterine scar pregnancy were retrospectively confir med,and the suspicious patients were excluded.Collecting Age,days of menopause,admission symptoms,admission blood HCG,body mass index,number of abortions,number of cesarean sections,treatment methods,amount of surgical bleeding,telephone foll ow-up of the outcome of their second pregnancy(including infertility,intrauterine pregn ancy,full-term delivery,IVF-ET,RCSP,etc.)and related clinical data of recurrent cesarean scar pregnancy(including patient age,number of days of initial menopause,admission symptoms,admission blood HCG,body mass index,number of abortions,number of the number of cesarean section,the treatment method of the first CSP,the amount of bleeding in the first CSP operation,etc.).After screening,they were divided into normal intrauterine pregnancy group and RCSP group.Results A total of four hundred and fourteen first-time CSP patients were admitted during cesarean scar pregnancy,of whom 20(4.8%)patients with initial CSP failed to undergo close follow-up.During telephone follow-up of three hundred and ninety-four first-time CSP patients,forty(10.2%)first-time CSP patients had intrauterine pregnancy at the time of their second pregnancy(thirty-four had a smooth pregnancy without adverse pregnancy complications,underwent cesarean section at term,6 had induced abortion at the early stage of pregnancy due to personal factors),three hundred and twenty-seven(83%)patients had no second pregnancy(five had selective sterilization,twelve had no contraception,three hundred and ten had no pregnancy temporarily).Of the planned,strict contraception,twenty-seven(6.8%)were pregnant with RCSP at the time of re-pregnancy,of which one patient with recurrent CSP had a second relapse and one patient had a normal intrauterine pregnancy after RCSP.Univariate analysisshowed that the outcome of the first CSP pregnancy was related to normal intrauterine pregnancy and RCSP.There were no significant differences between the two groups in the number of days of menopause,body mass index,number of abortions,amount of bleeding during the first CSP operation,type of the first CSP operation and clinical symptoms(P >0.05).In the initial CSP operation classification,nineteen cases(47.5%)in the normal intrauterine pregnancy group type 1,eight cases(29.6%)in the RCSP group,and the proportion of type II and III was equal in the two groups.The initial CSP operation method,twenty-eight cases(70%)in the normal intrauterine pregnancy group were treated with hysteroscopic cesarean scar pregnancy lesion resection and twenty-eight cases(44.4%)in the RCSP group,eleven cases(27.5%)in the normal intrauterine pregnancy group and ight cases(29.6%)in the RCSP group were treated with Ultrasound-guided uterine curettage was performed,Laparoscopic surveillance of cesarean scar pregnancy lesion resection(three cases),transabdominal cesarean scar lesion resection(one case),UAE + B ultrasound-guided uterine curettage(two cases)only in the RCSP group.There was no significant difference between the normal intrauterine pregnancy group and the RCSP group in the clinical symptoms related to the initial CSP admission.Five of the first CSP patients in the two groups were admitted to hospital for a large amount of vaginal bleeding after induced abortion,and twenty-three patients were admitted without relevant clinical symptoms,and were confirmed by vaginal ultrasound.Most of the first CSP clinical symptoms in the two groups were vaginal bleeding.The RCSP group was older than the normal intrauterine pregnancy group(P=0.017);the blood HCG value of the first CSP admission was higher in the RCSP group than in the normal intrauterine pregnancy group(P=0.012);the number of previous cesarean deliveries(p=0.033),with statistical differences.The binary logistic regression model analysis showed that for every increase in the number of cesarean sections,the likelihood of a second pregnancy outcome of RCSP was 5.134 times higher than that of intrauterine pregnancy;for every increase in age,the likelihood of RCSP was 1.226 times higher than that of intrauterine pregnancy.Conclusion Although normal intrauterine pregnancy is still possible after successful treatment of cesarean scar pregnancy,it still has a high recurrence rate and will seriously affect the physical and mental health of patients.The older age of the initial CSP patients,the higher HCG of the initial CSP patients,and the higher number of previous cesarean sections increase the risk of RCSP to some extent.For the first CSP patients with fertility requirements,if they are older,have a high HCG in the first CSP blood,and have a history of multiple cesarean deliveries,they need to provide multidisciplinary facility care when they are pregnant again,in order to maximize the possibility of safety outcomes in high-risk patients,and be alert to the occurrence of RCSP.