| Objective:To investigate the risk factors of massive hemorrhage during the treatment of type II cesarean scar pregnancy,and analyze the clinical efficacy of two treatment options: the curettage and the curettage after intervention,so as to provide reference for the treatment of type II scar pregnancy.Methods:A total of 112 patients with type II scar pregnancy admitted to our hospital from January 2015 to October 2020 were retrospectively analyzed,including 81 patients undergoing curettage and 31 patient undergoing curettage after uterine artery embolization.The clinical efficacy of the two treatment options were analyzed and compared.The patients with an intraoperative bleeding volume≥200 ml were included in the bleeding group(n=21)and those with the bleeding volume < 200 ml were included in the observation group(n=60).The differences in clinical data and ultrasonic parameters were compared between the two groups.The receiver operating characteristic(ROC)curve of the subjects was drawn for the factors with statistical difference,and the optimum critical point was obtained.At this critical point,independent variable factors were transformed into binary variables,which were included in the multivariate logistic regression analysis.The independent risk factors of massive bleeding during the curettage were analyzed,and the scoring system was established according to the OR value.Results:(1)The difference in the amount of bleeding,length of stay,and more than 80%of decrease in blood HCG was statistically significant(P<0.05)between the curettage group and intervention group.(2)Univariate analysis showed that the difference in age,number of cesarean sections,pregnancies,menopause time,gestational sac diameter and presence of fetal heart was not statistically significant(all P>0.05)between the curettage with bleeding group and control group.The difference in preoperative HCG level,thickness of myometrium with uterine scars and abundance of blood flow was statistically significant(all P﹤0.05).(3)The receiver operating characteristics(ROC)curve of the subjects with statistically different factors in univariate analysis was drawn.The ROC area under the curve(AUC)of blood HCG level was 0.730,the 95% confidence interval(CI)was 0.611-0.849,the optimum critical point was 82242 m IU/ml,the sensitivity was71.43%,and the specificity was 76.67%.The ROC AUC of scar thickness was 0.713,the 95% CI was within 0.86-0.839,the optimum critical point of scar thickness was1.85 mm,the sensitivity was 52.38%,and the specificity was 83.33%.(4)Taking the optimum critical point in the ROC curve as the boundary,the factors with statistical significance in the univariate analysis were converted into binary variables.Results of binary logistic regression analysis: scar thickness≤1.85 mm,OR 8.495,95% CI(1.554-46.432),P=0.014;HCG levels≥82244m IU/ml before this pregnancy,OR 14.860,95% CI(2.811-78.553),P=0.001;rich in blood flow,OR 10.787,95% CI(1.561-74.551),P=0.016.The bleeding scoring system was established according to the OR value.The AUC was0.893,95% CI was 0.820-0.966,the score of the optimum critical point was 13.0,the sensitivity here was 90.48%,and the specificity was 73.33%.Conclusion:(1)The bleeding volume of intervention group is less than that of curettage group,but the length of stay and proportion of patients with 80% of decrease in blood HCG are greater than those of curettage group.(2)The scar thickness,preoperative blood HCG level and blood flow abundance are the risk factors for massive bleeding during the curettage.When the scar thickness≤1.85 mm,HCG level≥82244 m IU/ml and the blood flow is abundant,the risk of uterine bleeding during the curettage is increased,and UAE pretreatment is recommended.(3)According to the scoring system,for patients with a total score<13 points and a little benefit in interventional operation,the curettage can be performed directly after the rescue preparation;for patients with the total score≥13 points,the UAE pretreatment or other operation methods may be chosen as appropriate. |
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