Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
Ultrasound Obstet Gynecol. 2016 Apr;47(4):506-10. doi: 10.1002/uog.14877.
To determine whether Cesarean scar defect (CSD) parameters assessed by transvaginal sonography (TVS) might affect the outcome of early termination of pregnancy (TOP) with mifepristone-misoprostol.
This was a retrospective review of 183 women with previous Cesarean delivery who received oral mifepristone and misoprostol for TOP. A successful TOP was defined by the absence of an intrauterine gestational sac, with no need for surgical intervention. CSD was diagnosed by TVS in the presence of a hypoechogenic indentation within the myometrium of the lower uterine segment at the site of a previous Cesarean incision. Women were analyzed in three subgroups according to size of defect (ratio of residual myometrial thickness over the defect to adjacent myometrial thickness < 30%, 30%-70% and > 70%).
Of the 183 women, 43 (23.5%) had failure of TOP. Fifty-nine (32.2%) had CSD detectable at TVS, and these women had a higher failure rate of TOP than did those without CSD (38.9% vs 16.1%; P = 0.001). CSD was associated significantly with failure of TOP (odds ratio, 3.32 (95% CI, 1.64-6.75)). The TOP failure rates in relation to defect size in the myometrial thickness ratio < 30%, 30%-70% and > 70% subgroups were 57.1%, 25.0% and 18.2%, respectively. There was a linear trend in failure rate across these ratios (Cochran-Armitage trend test; P = 0.015).
Women with CSD are at increased risk of failed TOP. Women with a defect in which the residual myometrial thickness was < 30% of the adjacent myometrial thickness tended to have a greater chance of failed TOP. CSD detected at TVS is of clinical relevance in counseling women with a history of Cesarean delivery who are considering TOP. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
探讨经阴道超声（TVS）评估的剖宫产子宫瘢痕缺陷（CSD）参数是否会影响米非司酮联合米索前列醇终止早期妊娠（TOP）的结局。
这是一项回顾性研究，共纳入 183 例有剖宫产史并接受米非司酮和米索前列醇行 TOP 的患者。成功的 TOP 定义为宫腔内未见妊娠囊，无需手术干预。CSD 通过 TVS 诊断，即在先前剖宫产切口部位的子宫下段肌层内可见低回声凹陷。根据缺陷处残余肌层厚度与相邻肌层厚度的比值（<30%、30%-70%和>70%）将患者分为 3 个亚组进行分析。
183 例患者中，43 例（23.5%）发生 TOP 失败。59 例（32.2%）TVS 可检测到 CSD，这些患者的 TOP 失败率高于未检测到 CSD 的患者（38.9% vs. 16.1%；P=0.001）。CSD 与 TOP 失败显著相关（优势比，3.32（95%可信区间，1.64-6.75））。在残余肌层厚度比值<30%、30%-70%和>70%的亚组中，TOP 失败率分别为 57.1%、25.0%和 18.2%，各亚组间失败率呈线性趋势（Cochran-Armitage 趋势检验；P=0.015）。
有 CSD 的患者 TOP 失败风险增加。残余肌层厚度<相邻肌层厚度 30%的患者发生 TOP 失败的可能性更大。CSD 是剖宫产史患者行 TOP 前咨询的重要临床指标。版权所有©2015ISUOG。由 John Wiley & Sons Ltd 出版。
