The Study Of Clinical Characteristics And Treatment In Cesarean Scar Pregnancy

Objective:To analyze the distribution of clinical features and the choice of surgical methods in patients with different types of Cesarean scar pregnancy(CSP),and to summarize the diagnosis and treatment rules to provide guidance for the clinical research and treatment of CSP.Materials and methods:A retrospective study was performed on 76 patients with CSP who were admitted to our Department of Obstetrics and Gynecology from January 2014 to December 2018.76 patients were classified into three types according to the ultrasound image: Type?(complete gestational sac implanted in the lower segment of uterus,the thickness of the uterine layer of the gestational sac and the bladder is>3mm),type ?(complete gestational sac implanted in the lower segment of uterus,the thickness of the uterine layer in the gestational sac and the bladder is ?3mm),type ?(pregnancy cystic and mass in deep muscular layer,and the thickness of the myometrium between the gestational sac and the bladder is ?3mm,which is obviously thin or even missing.Analyze its clinical features,and observe whether there are differences in the choice of various surgical methods in different types and clinical features.Statistical analysis was performed using SPSS 17.0 software.Results:1.From January 2014 to December 2018,76 patients with CSP admitted to our Department of Obstetrics and Gynecology,including 33 cases of CSP?,accounting for 43.42%;25 cases of CSP?,accounting for 32.89%;18 cases of CSP?,accounting for 23.68%.And the incidence rate was generally Upward trend.2.The age of 76 patients with CSP was normal distribution,of which 30 to 34 years old were the most common,followed by 35 to 39 years old and 25 to 29 years old,accounting for 36.84%,25.00%,and 23.69%,respectively.There was no significant difference in the mean age of onset among patients in each year(P>0.05).3.The mean age,number of abortions,number of cesarean section,time from previous cesarean section and amenorrhea time in the three groups of CSP patients in 76 patients with CSP showed no significant difference(P>0.05).4.The mean values of the maximum diameter of the gestational sac or mass in 76 patients with different types of CSP were 2.62±1.25 cm(CSP?),3.34±1.21cm(CSP?),and 4.27±2.10cm(CSP?),the difference was statistically significant(P<0.05).The maximum diameter of the gestational sac of CSP? patients may be larger than that of CSP? and CSP?.There was also a statistically significant difference in the ratio of the maximum diameter of the gestational sac in the three types of CSP patients(P<0.05).In the gestational sac maximum diameter?5cm,CSP? occupies the largest proportion.In the gestational sac maximum diameter<3cm,?3cm~<5cm,CSP?and CSP? are dominant.5.There were statistically significant differences in fetal heartbeat between 76 patients with different types of CSP(P<0.05).The proportion of CSP?and CSP? fetal heartbeat is larger than that of CSP?,and the proportion of CSP? type fetal heartbeat isn't larger than that in CSP?and CSP?.6.The distribution of serum hCG before treatment in 76 patients with different types of CSP was statistically significant(P<0.05).Before treatment,serum hCG?5000IU/L,mainly CSP?,and patients with hCG>5000IU/L were mainly CSP?.7.The proportion of clinical manifestations of 76 patients with different types of CSP was statistically significant.Among them,CSP?and CSP? had the largest proportion of painless vaginal bleeding after amenorrhea,while vaginal bleeding was the most common after CSP? abortion.8.The most common treatments for patients with CSPI and type II are uterine artery embolization / uterine arterial chemoembolization + ultrasound / hysteroscopy monitoring of scar tissue removal + curettage,and CSP? patients with open/laparoscopic scar pregnancy resection plus uterus repair.9.When the maximum diameter of the gestational sac>5 cm,the first uterine artery embolization / uterine arterial chemoembolization,combined with other surgical methods,or open / laparoscopic scar lesion removal + uterine repair is a safer choice;when the initial HCG value>5000IU/L or live birth,the risk of bleeding is greater.Conclusion:1.The number of CSP patients showed an overall upward trend,and the CSP?and CSP? increased more significantly.2.There is a difference in the distribution of the maximum diameter of the gestational sac,the serum HCG level and fetal heartbeat in different types of CSP.3.The clinical manifestations of patients with CSP are mainly painless vaginal bleeding after amenorrhea.4,The CSP classification,the maximum diameter of the gestational sac,the fetal heartbeat and the level of serum hCG before treatment have important clinical significance for the selection of individualized treatment options for CSP patients.