He F, Li J Q, Tang X L, Lin Y, Su C H, Chen D J
Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Obstetrics Critical Care Center, Guangzhou 510150, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Sep 25;52(9):594-599. doi: 10.3760/cma.j.issn.0529-567X.2017.09.004.
To explore the natural courses of 11 patients with cesarean scar pregnancy (CSP) with expectant management. Eleven patients with CSP who were diagnosed in the first trimester in the Third Affiliated Hospital of Guangzhou Medical University from January 2015 to March 2017 were recruited. All of them received expectant management. Nine pregnancies continued to the third trimester (the third trimester group), and 2 patients were expected to the second trimester (the second trimester group). The gestational age at diagnosis, CSP type, gravidity, parity, miscarriage and previous cesarean section history, gestational weeks at termination, amount of postpartum hemorrhage, prenatal and postnatal hemoglobin levels, pregnancy outcomes and obstetric complications were compared between the two groups. The third trimester group terminated pregnancies between 33(+2) and 36(+5) weeks. The second trimester group terminated in the second trimester because of rupture of uterus (at 17(+2), 17(+3) weeks). There was no statistical difference between the two groups regarding the number of gravidity, parity and previous cesarean section (all 0.05) . The number of miscarriage in the second trimester group was 4.0±2.8, and in the third trimester group was 1.3±1.1 (0.05) . In the third trimester group, 7 cases were CSP typeⅠand 2 cases were CSPⅡ. In the second trimester group, 2 cases were both CSP type Ⅲ. Eleven cases were diagnosed placenta accreta pathologically. There was no maternal death, and 6 cases received hysterectomy (6/11). The amount of postpartum hemorrhage increased remarkably and all neonates survived (pregnancy terminated between 33(+2) and 36(+5) weeks). s For those diagnosed as CSP typeⅠandⅡwho urge to continue pregnancies, it's plausible to have expectant management with fully consent of obstetric hemorrhage, rupture of uterus and hysterectomy and close monitoring in tertiary hospital. The detailed expectant management of CSP is needed further exploration.
探讨11例接受期待治疗的剖宫产瘢痕妊娠（CSP）患者的自然病程。选取2015年1月至2017年3月在广州医科大学附属第三医院孕早期诊断为CSP的11例患者。所有患者均接受期待治疗。9例妊娠持续至晚期妊娠（晚期妊娠组），2例患者持续至中期妊娠（中期妊娠组）。比较两组患者的诊断时孕周、CSP类型、孕次、产次、流产史及既往剖宫产史、终止妊娠孕周、产后出血量、产前及产后血红蛋白水平、妊娠结局及产科并发症。晚期妊娠组在33（+2）至36（+5）周之间终止妊娠。中期妊娠组因子宫破裂（分别在17（+2）、17（+3）周）于中期妊娠终止。两组患者的孕次、产次及既往剖宫产次数差异均无统计学意义（均P>0.05）。中期妊娠组流产次数为4.0±2.8次，晚期妊娠组为1.3±1.1次（P<0.05）。晚期妊娠组中，CSPⅠ型7例，CSPⅡ型2例。中期妊娠组2例均为CSPⅢ型。11例病理诊断为胎盘植入。无孕产妇死亡，6例接受子宫切除术（6/11）。产后出血量显著增加，所有新生儿均存活（妊娠在33（+2）至36（+5）周之间终止）。对于诊断为CSPⅠ型和Ⅱ型且强烈要求继续妊娠的患者，在充分告知产科出血、子宫破裂及子宫切除风险并获得患者充分知情同意后，在三级医院进行密切监测下给予期待治疗是可行的。CSP详细的期待治疗方案仍需进一步探索。
