| Objective:The purpose of this study is to collect domestic and foreign literatures related to the outcome of second pregnancy after cesarean scar pregnancy(CSP)treatment,extract the data in the literatures for Meta-analysis,and finally evaluate the situation of second pregnancy after CSP treatment through the second pregnancy rate after CSP treatment,recurrence rate,spontaneous abortion rate,full-term live birth rate,incidence of placental diseases,incidence of complete/incomplete uterine rupture and compare the effect of different treatment methods on the outcome of second pregnancy after CSP treatment,providing a reference for obstetrics and gynecology clinicians.Methods:We conducted a systematic literature search of foreign language databases(Pub Med,Web of science,Embase,Cochrane Library)and Chinese databases(CNKI,Wanfang database,CBM,VIP Chinese scientific journal database)to search each database for articles published from January 2000 to December 2020 on second pregnancy after cesarean scar pregnancy treatment.The literatures were screened according to the inclusion and exclusion criteria.The Newcastle-Ottawa Scale(NOS scale)and MINORS scoring scale of non-randomized controlled clinical trials were used to evaluate the quality of the included literatures.Meta-analysis was performed by the statistical software R4.0.3.Results:Meta-analysis of the 51 included articles yielded the following results:1.The second pregnancy rate after CSP treatment was 73%;the second pregnancy rate in the surgery group(94%)was higher than that in the MTX group(62%)and uterine curettage group(75%),and the difference was significant(P <0.05).The second pregnancy rate in the non-UAE group(78%)was higher than that in the UAE combined with uterine curettage group(74%),and the difference was not significant(P > 0.05).The second pregnancy rate in laparotomy group(95%)was higher than that in laparoscopy group(86%),and the difference had no statistical significance(P > 0.05).2.The recurrence rate of second pregnancy after CSP treatment was 9%;among them,the recurrence rate in the surgery group(2%)was lower than that in the MTX group(5%)and uterine curettage group(11%),and the difference was significant(P <0.05).The recurrence rate of uterine curettage in non-UAE group(11%)was lower than that in UAE combined with uterine curettage group(12%),and the difference had no significance(P > 0.05).The recurrence rate in laparoscopic surgery group(1%)and laparotomy group(1%)was lower than that in vaginal surgery group(6%),and the difference had no statistical significance(P > 0.05).3.Spontaneous abortion rate of second pregnancy after CSP treatment was 11%,and the spontaneous abortion rate in MTX group(14%)was higher than that in uterine curettage group(12%)and surgery group(12%),and the difference was not significant(P > 0.05).The spontaneous abortion rate in UAE combined with uterine curettage group(13%)was higher than that in non-UAE uterine curettage group(9%),and the difference was not significant(P > 0.05).The spontaneous abortion rate in laparotomy group(18%)was higher than that in laparoscopy group(7%)and vaginal surgery group(8%),and the difference had no significance(P > 0.05).4.61% of full-term live births were achieved in the second pregnancy after CSP treatment,and the full-term live birth rate in the surgery group(74%)was higher than that in the MTX group(56%)and uterine curettage group(59%),and the difference was not significant(P > 0.05).The term live birth rate in the UAE combined with uterine curettage group(68%)was higher than that in the non-UAE uterine curettage group(56%),and the difference was not significant(P > 0.05).The term live birth rate was higher in the laparoscopic surgery group(65%)and open surgery group(65%)than in the vaginal surgery group(46%),and the difference was not significant(P >0.005).5.The incidence of placental disease in the second pregnancy after CSP treatment was 2%;among them,the incidence of placental disease in the MTX group(3%)was higher than that in the uterine curettage group(2%),and the difference was not significant(P > 0.05).The incidence of placental disease in the non-UAE group(3%)was higher than that in the UAE combined with uterine curettage group(1%),and the difference was not significant(P > 0.05).6.A total of 14 articles(including 387 cases of second pregnancy after CSP treatment)described the occurrence of complete/incomplete uterine rupture in second pregnancy after CSP treatment.Among them,only 7 patients in 3 literatures had complete/incomplete rupture of uterus in the second pregnancy.Conclusion:1.The overall pregnancy outcome of CSP patients during the second pregnancy after treatment is good,but there is still a risk of recurrence,abortion,premature delivery,placenta accreta,and uterine rupture,which requires close monitoring during pregnancy and delivery.2.When CSP patients were pregnant again after treatment,the pregnancy rate was highest in the surgery group,followed by the uterine curettage group,and lowest in the MTX group.3.When CSP patients were pregnant again after treatment,the recurrence rate was lowest in the surgery group,followed by the MTX group,and highest in the uterine curettage group. |
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