Seow Kok-Min, Hwang Jiann-Loung, Tsai Yieh-Loong, Huang Lee-Wen, Lin Yu-Hung, Hsieh Bin-Chwen
Department of Obstetrics and Gynecology, Shin-Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.
Acta Obstet Gynecol Scand. 2004 Dec;83(12):1167-72. doi: 10.1111/j.0001-6349.2004.00445.x.
To assess pregnancy course and outcome after conservative treatment of a cesarean scar pregnancy.
During an 8-year period, 15 cases of cesarean scar pregnancies were diagnosed at our institution. Seven of the 14 patients for whom we successfully preserved the uterus became pregnant within 3 years after termination of the scar pregnancy. The year of diagnosis, conservative method and gestational age for these five patients were recorded. Delivery method, time interval between the scar pregnancy and subsequent pregnancy, and maternal and neonatal outcome were evaluated.
Seven pregnancies (eight live and one dead baby) were noted. The mean interval between the ectopic pregnancy and subsequent pregnancy was 13.3 months (range 0-34 months). One patient, who became pregnant 3 months after the scar pregnancy was found, suffered uterine rupture at 38.3 weeks' gestational age. Two patients with placental accrete, and one of them who continued the existing intrauterine twin pregnancy after transvaginal sono-guided aspiration of the scar pregnancy received a cesarean hysterectomy at 32 weeks of gestation. The remaining four pregnancies were uneventful, followed by early cesarean sections at 36 weeks.
The results of this first series of seven subsequent pregnancies after conservative treatment of scar pregnancies are promising. An early cesarean section before over-extension of the uterus and spontaneous labor can help to prevent uterine rupture. Placenta accrete is another severe morbidity of these patients in addition to uterine rupture. Thus a cesarean hysterectomy may be the choice of treatment.
评估剖宫产瘢痕妊娠保守治疗后的妊娠过程及结局。
在8年期间，我院诊断出15例剖宫产瘢痕妊娠。14例成功保留子宫的患者中，7例在瘢痕妊娠终止后3年内怀孕。记录这5例患者的诊断年份、保守治疗方法及孕周。评估分娩方式、瘢痕妊娠与后续妊娠的时间间隔以及母婴结局。
记录到7次妊娠（8个活婴和1个死胎）。异位妊娠与后续妊娠的平均间隔为13.3个月（范围0 - 34个月）。1例在发现瘢痕妊娠3个月后怀孕的患者，在孕38.3周时发生子宫破裂。2例患者发生胎盘植入，其中1例在经阴道超声引导下抽吸瘢痕妊娠后继续宫内双胎妊娠，于孕32周行剖宫产子宫切除术。其余4次妊娠过程顺利，于孕36周行早期剖宫产。
这一系列7例瘢痕妊娠保守治疗后的后续妊娠结果令人鼓舞。在子宫过度伸展和自然分娩前尽早行剖宫产有助于预防子宫破裂。除子宫破裂外，胎盘植入是这些患者的另一种严重并发症。因此，剖宫产子宫切除术可能是治疗的选择。
