Clinical Analysis Of Different Methods Of Termination Of Cesarean Scar Pregnancy And Scar Uterus In Second Trimester

Part1.Clinical analysis of different treatments for cesarean scar pregnancyPurpose:By analyzing the clinical outcomes of cesarean scar pregnancy under different treatments,the advantages and disadvantages of various treatment methods and their curative effects were analyzed.Methods:From September 2012 to November 2021,190 patients diagnosed with cesarean scar pregnancy（CSP）and hospitalized in our hospital were retrospectively selected and divided into three groups according to the different methods of pregnancy termination.Ultrasound-guided curettage was performed in group A（50 patients）;methotrexate local injection therapy combined with ultrasound-guided curettage was performed in group B（70 patients）;uterine artery embolization combined with ultrasound-guided curettage was performed in group C（70 patients）.The intraoperative conditions,the time taken for the human chorionic gonadotropin（HCG）to turn negative,the degree of postoperative haemoglobin（HGB）drop,the number of days in hospital and the cost of each treatment option were compared among the patients in each group.Result:1.Treatment success rate:96.00%in Group A,91.43%in Group B,98.57%in Group C.There was no statistically significant difference between the three groups（P>0.05）.2.Intraoperative bleeding and postoperative complications:Group C had the least intraoperative bleeding,which was statistically significantly different from Group A and Group B（P<0.05）,and there was no significant statistical difference between Group A and Group B（P>0.05）.1 case in Group A had fever after the operation;3 cases in Group B had fever after the operation;16 cases in Group C had fever and 28 cases had limb pain symptoms after the operation.3.The decline in HGB and the time to turn negative in blood HCG after treatment:Group C had the least decline in HGB,which was statistically significantly different from the remaining two groups（P<0.05）,and there was no significant statistical difference between groups A and B（P>0.05）.The time to turn negative in blood HCG was the shortest in group C,which was statistically significantly different from the remaining two groups（P<0.05）,and there was no significant statistical difference between groups A and B（P>0.05）.4.Hospitalization time and hospitalization cost:Group C had the shortest hospitalization time and Group B had the longest hospitalization time,with statistically significant differences between the three groups（P<0.05）;Group A had the least hospitalization cost and Group C had the most,with statistically significant differences between the three groups（P<0.05）.5.Treatment of type Ⅰ CSP:intraoperative bleeding in group A was more than that in group B.The length of hospital stay and hospital costs were lower than those in group B.There was a statistically significant difference between the two groups（P<0.05）,and there was no statistically significant difference between the two groups in terms of treatment success rate,degree of postoperative HGB decline and time for blood HCG to turn negative（P>0.05）.6.Treatment of type Ⅱ CSP:The intraoperative bleeding,postoperative HGB decline and hospitalization time in group C were all lower than those in group B.The treatment success rate and hospitalization cost were significantly higher than those in group B.There was a statistical difference between the two groups（P<0.05）,and there was no statistical difference in the time for blood HCG to turn negative between the two groups（P>0.05）.Conclusion:1、Ultrasound-guided uterine curettage can be used as the preferred treatment for type Ⅰ CSP termination of pregnancy,with the advantages of low treatment cost,short hospitalization time and rapid postoperative recovery.2、Local injection of methotrexate combined with ultrasound-guided curettage can be used to treat type Ⅰ and type Ⅱ CSP,but the treatment time is relatively longer.3、Uterine artery embolization combined with ultrasound-guided curettage is suitable for type Ⅱ and Ⅲ CSP,which can effectively reduce intraoperative bleeding,shorten hospital stay and improve safety and success rate.The disadvantages are significantly more postoperative complications and high surgical costs.Part2.Clinical analysis of different termination of pregnancy in the second trimester of scar uterusPurpose:The advantages and disadvantages of various treatment methods were analyzed by comparing the labor induction outcomes of scar uterine patients in the second trimester of pregnancy under different pregnancy termination methods.Methods:A total of 170 scar uterine patients in the second trimester of pregnancy from September 2012 to November 2021 were retrospectively selected and divided into three groups according to the different treatment methods.The simple drug induction（mifepristone combined with misoprostol）was set as the drug group with 50 cases.After using oral mifepristone combined with misoprostol,the disposable balloon cervical dilator was set to the water sac group,with a total of 60 cases.Oral mifepristone combined with misoprostol was combined with ethacridine injection and disposable balloon cervical dilator,a total of 60 cases.The 170 patients were analyzed retrospectively to compare labor induction outcomes and postpartum complications in the three groups.Result:1.Success rate of production induction:80%in drug group,93.3%in water sac group,and 95%in ethacridine group;the lowest in drug group,with statistical difference from the other two groups（P<0.05）.2.Contraction initiation time:the ethacridine group had the shortest contraction initiation time and the longest drug group,and there were significant statistical differences between the three groups（P<0.05）.3.Total delivery time:the total birth time was the longest in the drug group,with significant statistical difference from the other two groups（P<0.05）,and no statistical difference between the water sac group and ethacridine group（P>0.05）.4.Hemorrhage at 24 hours postpartum:the most bleeding amount in the drug group,statistically different from the other two groups（P<0.05）,and no statistical difference between the water sac group and ethacridine group（P>0.05）.5.Placental fetal membrane residual rate and uterine clearance rate:the placenta fetal membrane residual rate and uterine clearance rate were the lowest in the water sac group,and the placenta fetal membrane residual rate and uterine clearance rate were the highest in the drug groups,there were statistical differences among the three groups（P<0.05）.6.Time of hospitalization:there was no statistical difference between the three groups（P>0.05）.Conclusion:1.Drug induced labor treatment is simple,but the placenta fetal membrane residual rate and curettage rate is significantly higher.2.The labor induction outcome of the water sac group and the ethacridine group is relatively satisfactory,and different treatment methods can be selected according to the wishes of the patients and combined with the clinical reality.3.A disposable cervical balloon dilator was used in both the water sac group and the ethacridine group in this study,but no uterine rupture occurred.Strictly grasp the indications,balloon dilator can also be used for scar uterine patients in the middle of pregnancy induction.