Timor-Tritsch Ilan E, Khatib Nizar, Monteagudo Ana, Ramos Joanne, Berg Robert, Kovács Sándor
Departments of Obstetrics and Gynecology (I.E.T.-T., N.K., A.M., J.R., R.B.) and Radiology (S.K.), New York University School of Medicine, New York, New York USA.
J Ultrasound Med. 2015 Apr;34(4):601-10. doi: 10.7863/ultra.34.4.601.
To evaluate the management, clinical courses, and outcomes of cesarean scar pregnancies diagnosed in the first trimester.
We identified 60 cases of cesarean scar pregnancies diagnosed between 5 and 14 weeks. Group A contained 48 patients with fetal/embryonic cardiac activity; group B comprised 12 patients without cardiac activity; and group C included 11 patients with cardiac activity who chose expectant management.
Five of the 48 patients (10.4%) in group A were successfully treated for vaginal bleeding. Thirty-three (68.7%) received methotrexate injections, and all had full resolution. Three (6.3%) required uterine artery embolization for late-developing arteriovenous malformations. Ten of the 12 patients (83.3%) in group B were managed expectantly and had full recovery. Two of the 10 (20.0%) had arteriovenous malformations; 1 had unsuccessful uterine artery embolization followed by a hysterectomy, and the second requested a hysterectomy. Ten of the 11 patients (90.9%) in group C continued the pregnancies. One declined local injection. Four of the 10 (40.0%) delivered live offspring by successive elective cesarean deliveries. Three (30.0%) had hysterectomies for placenta percreta, and 1 did not have a hysterectomy after delivery. Five (50%) had second-trimester complications, all leading to hysterectomies. Of the 60 patients, 20 (33.3%) had serious complications: 5 had arteriovenous malformations; 4 had uterine artery embolization; and 11 had hysterectomies.
A cesarean scar pregnancy is a serious complication for patients who have had cesarean deliveries. Counseling, treatment, and follow-up are challenging for patients and caregivers. However, emerging data from different management approaches confirm that a cesarean scar pregnancy may progress and result in a live neonate at the expense of further fertility. This study confirmed that expectant management of a cesarean scar pregnancy is associated with a high risk of hysterectomy due to morbidly adherent placenta.
评估孕早期诊断的剖宫产瘢痕妊娠的处理方式、临床病程及结局。
我们确定了60例在孕5至14周诊断为剖宫产瘢痕妊娠的病例。A组包含48例有胎儿/胚胎心搏的患者；B组由12例无心搏的患者组成；C组包括11例有心脏活动且选择期待治疗的患者。
A组48例患者中有5例（10.4%）成功治疗了阴道出血。33例（68.7%）接受了甲氨蝶呤注射，均完全消退。3例（6.3%）因后期出现动静脉畸形需要进行子宫动脉栓塞。B组12例患者中有10例（83.3%）进行了期待治疗并完全康复。10例中的2例（20.0%）有动静脉畸形；1例子宫动脉栓塞失败后行子宫切除术，另1例要求行子宫切除术。C组11例患者中有10例（90.9%）继续妊娠。1例拒绝局部注射。10例中的4例（40.0%）通过连续择期剖宫产分娩出活产婴儿。3例（30.0%）因穿透性胎盘植入行子宫切除术，1例分娩后未行子宫切除术。5例（50%）有孕中期并发症，均导致子宫切除术。60例患者中，20例（33.3%）有严重并发症：5例有动静脉畸形；4例进行了子宫动脉栓塞；11例进行了子宫切除术。
剖宫产瘢痕妊娠对有剖宫产史的患者来说是一种严重并发症。对患者和医护人员而言，咨询、治疗及随访都具有挑战性。然而，来自不同处理方式的新数据证实，剖宫产瘢痕妊娠可能进展并以牺牲进一步生育能力为代价娩出活产新生儿。本研究证实，剖宫产瘢痕妊娠的期待治疗因胎盘植入异常而导致子宫切除的风险很高。
