Institute of Women's Health, University College Hospital, London, UK.
Early Pregnancy Unit, King's College Hospital, London, UK.
Ultrasound Obstet Gynecol. 2016 Apr;47(4):511-7. doi: 10.1002/uog.15857.
To assess the efficacy of ultrasound-guided suction curettage for management of pregnancies implanted into the lower uterine segment Cesarean section scar.
This was a retrospective study including women diagnosed with Cesarean section scar pregnancy at two large tertiary referral early pregnancy units between 1997 and 2014. Surgical evacuation was offered to selected women presenting in the first trimester ≤ 14 weeks' gestation. All procedures were performed transcervically under ultrasound guidance using suction curettage. A modified Shirodkar cervical suture was used in women who required additional measures to secure hemostasis.
A total of 232 women with Cesarean section scar pregnancy were seen at the referral units; 191/232 (82.3%) women were treated surgically. The median intraoperative blood loss was 100 mL (range, 10-3000 mL); 9/191 (4.7% (95% CI, 1.7-7.7%)) women required blood transfusion and, in one (0.5% (95% CI, 0-1.5%)), life-saving hysterectomy had to be performed because of uncontrollable intraoperative bleeding. Of the women who attended for follow-up, 7/116 (6.0% (95% CI, 1.7-10.3%)) required a repeat surgical procedure because of retained products of conception. Multivariable analysis showed that the gestational sac diameter (odds ratio (OR), 1.10 (95% CI, 1.03-1.17)) and pregnancy vascularity on Doppler examination (OR, 3.41 (95% CI, 1.39-8.33)) were significant predictors of heavy intraoperative blood loss (> 1000 mL).
Ultrasound-guided suction curettage is an effective method for the treatment of pregnancies implanted into a lower uterine segment Cesarean section scar and is associated with a low risk of blood transfusion and hysterectomy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
评估超声引导下吸刮术治疗子宫下段剖宫产瘢痕妊娠的疗效。
这是一项回顾性研究，纳入了 1997 年至 2014 年期间在两个大型三级转诊早孕单位诊断为剖宫产瘢痕妊娠的妇女。对妊娠≤14 周（第一孕期）的患者选择性行手术清除。所有操作均在超声引导下经宫颈进行，采用吸刮术。对于需要额外措施以确保止血的患者，使用改良的 Shirodkar 宫颈缝线。
转诊单位共诊治了 232 例剖宫产瘢痕妊娠患者；191/232（82.3%）例患者接受了手术治疗。术中中位出血量为 100ml（范围 10-3000ml）；9/191（4.7%（95%CI，1.7-7.7%））例患者需要输血，1 例（0.5%（95%CI，0-1.5%））因术中无法控制的出血而行挽救生命的子宫切除术。在接受随访的患者中，7/116（6.0%（95%CI，1.7-10.3%））例因有妊娠物残留而需要再次手术。多变量分析显示，妊娠囊直径（比值比（OR），1.10（95%CI，1.03-1.17））和多普勒检查的妊娠血管（OR，3.41（95%CI，1.39-8.33））是术中大量出血（>1000ml）的显著预测因子。
超声引导下吸刮术是治疗子宫下段剖宫产瘢痕妊娠的有效方法，其输血和子宫切除术的风险较低。版权所有 © 2016 ISUOG。由 John Wiley & Sons Ltd 出版。
