Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith and OMNI Gynecological Care, Centre for Women's Ultrasound and Early Pregnancy, St Leonard's, Sydney, Australia.
Ultrasound Obstet Gynecol. 2010 Apr;35(4):481-5. doi: 10.1002/uog.7596.
To describe a new technique for the management of Cesarean scar ectopic pregnancy (CSEP): transrectal ultrasound (TRS)-guided surgical evacuation.
All women who presented at our early pregnancy units (EPU) from November 2006 to July 2008 underwent transvaginal sonography. CSEP was diagnosed if all of the following criteria were met: absence of an intrauterine pregnancy; empty endocervical canal; presence of a gestational sac implanted within the lower anterior segment of the uterine corpus, with or without evidence of myometrial thinning. Women were offered TRS-guided surgical evacuation under general anesthesia. Successful treatment was defined as complete primary evacuation of the CSEP. The need to perform additional interventions (emergency cervical cerclage, insertion of Foley's balloon catheter, blood transfusions) was recorded.
Of 1195 consecutive women who presented at the EPUs, seven (0.59%) were diagnosed with CSEP. Three (43%) of these were viable at the time of diagnosis. Two (29%) of the seven pregnancies followed in-vitro fertilization; six (86%) women had previously had a single Cesarean section and one had had two. One of these women had a previous tubal ectopic pregnancy, and one a previous CSEP. Three (43%) of the women were asymptomatic. Five (71%) women were treated with TRS-guided surgical evacuation as the primary treatment, whilst two (29%) were given systemic methotrexate, one of whom subsequently underwent TRS-guided aspiration because of failure of conservative management. There were no major complications.
The best treatment for CSEP has yet to be established. TRS-guided surgical evacuation is a novel and potentially alternative treatment modality. However, in the absence of further studies we cannot draw any conclusions, and the management of such women should be individualized.
描述一种治疗剖宫产瘢痕部位妊娠（CSEP）的新技术：经直肠超声（TRS）引导下手术清除。
2006 年 11 月至 2008 年 7 月期间，所有在我们的早孕门诊就诊的妇女均接受经阴道超声检查。如果符合以下所有标准，则诊断为 CSEP：宫腔内未见妊娠；宫颈管内空虚；妊娠囊位于子宫下段前壁，伴或不伴子宫肌层变薄。对这些患者行全身麻醉下 TRS 引导下手术清除。成功治疗定义为 CSEP 完全初次清除。记录是否需要进行额外的干预（紧急宫颈环扎术、放置 Foley 球囊导管、输血）。
在 1195 例连续就诊于早孕门诊的妇女中，有 7 例（0.59%）被诊断为 CSEP。其中 3 例（43%）在诊断时存活。7 例妊娠中有 2 例（29%）是通过体外受精受孕的；6 例（86%）妇女曾有过一次剖宫产史，1 例有过两次剖宫产史。其中 1 例有过输卵管异位妊娠史，1 例有过 CSEP 史。3 例（43%）患者无症状。5 例（71%）患者作为主要治疗方法行 TRS 引导下手术清除，2 例（29%）患者接受全身甲氨蝶呤治疗，其中 1 例因保守治疗失败而行 TRS 引导下抽吸。无严重并发症。
CSEP 的最佳治疗方法尚未确定。TRS 引导下手术清除是一种新颖的、潜在的替代治疗方法。但是，在没有进一步研究的情况下，我们不能得出任何结论，此类患者的处理应个体化。
