Yin Ling, Tao Xia, Zhu Yu-chun, Yu Xiao-lan, Zou Ying-hua, Yang Hui-xia
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 Aug;44(8):566-9.
To discuss the diagnosis and treatment strategy of cesarean scar pregnancy (CSP).
Forty-two cases of CSP admitted to Peking University First Hospital from Jan. 2003 to Dec. 2008 were analyzed retrospectively, and the clinical characteristics, pelvic Doppler ultrasonography report, management including methotrexate (MTX) therapy, bilateral uterine artery embolism (UAE), curettage and hysterectomy of these 42 women were reviewed. The percentage of human chorionic gonadochopin (hCG) reduction, menstrual period after the treatment of her CSP and recurrent pregnant outcome were also followed.
Among the 42 CSP women, 24 (57%) presented with vaginal bleeding, 3 (7%) with lower abdominal pain. The interval between CSP and the last cesarean scar (CS) was 0.5 - 18.0 years and the average duration of gestation was (60 +/- 18) days. Fourteen cases (33%) were finally diagnosed as CSP in our hospital followed by failure of abortion due to misdiagnosed as early uterine pregnancy in other hospitals; one (2%) was finally diagnosed after hysterectomy due to excessive bleeding during curettage because of suspected hydatidiform mole under color sonography; one was diagnosed by MRI after color sonography; the rest 25 women (60%) were all confirmed by color sonography before management. Treatment of these cases included curettage after UAE (17 cases), curettage after UAE and MTX (13 cases), curettage after MTX only (4 cases), MTX only (4 cases) and others (4 cases). No significant difference was found in the average duration of pregnancy, average reduction of serum level of hCG and the operation time for curettage between the first two management group (P > 0.05). All of the 42 cases fully recovered before discharge and the recovery time of menses was averagely (32 +/- 10) days (10 - 60 days) after curettage and 5 reported reduced menstrual blood volume. Three out of the 42 women were pregnant again during follow-up and 1 delivered by CS at 39 weeks of gestation one year after without any complications or CSP.
CSP is not common and can be easily misdiagnosed and color ultrasound scan is important in its early diagnosis. UAE combined with MTX followed by curettage is an effective treatment of CSP.
探讨剖宫产瘢痕妊娠（CSP）的诊断及治疗策略。
回顾性分析2003年1月至2008年12月北京大学第一医院收治的42例CSP患者，复习其临床特征、盆腔多普勒超声报告及治疗情况，包括甲氨蝶呤（MTX）治疗、双侧子宫动脉栓塞术（UAE）、刮宫术及子宫切除术。随访患者治疗后血人绒毛膜促性腺激素（hCG）下降百分比、月经恢复情况及再次妊娠结局。
42例CSP患者中，24例（57%）出现阴道流血，3例（7%）有下腹疼痛。CSP距上次剖宫产瘢痕的时间间隔为0.5～18.0年，平均孕周为（60±18）天。14例（33%）患者在我院最终确诊为CSP，此前在其他医院因误诊为早期宫内妊娠而流产失败；1例（2%）因彩色超声怀疑葡萄胎刮宫时出血过多行子宫切除术后最终确诊；1例经彩色超声后MRI确诊；其余25例（60%）在治疗前均经彩色超声确诊。治疗方法包括UAE后刮宫（17例）、UAE联合MTX后刮宫（13例）、单纯MTX后刮宫（4例）、单纯MTX（4例）及其他（4例）。前两组在平均孕周、血清hCG平均下降值及刮宫手术时间方面差异无统计学意义（P＞0.05）。42例患者均痊愈出院，刮宫术后月经恢复时间平均为（32±10）天（10～60天），5例报告月经量减少。42例患者中有3例在随访期间再次妊娠，1例在1年后孕39周行剖宫产分娩，无任何并发症及CSP复发。
CSP并不常见，易误诊，彩色超声检查对其早期诊断至关重要。UAE联合MTX后刮宫是治疗CSP的有效方法。
