State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University , Chongqing , China.
Department of Obstetrics and Gynaecology, Suining Central Hospital , Suining , China.
Int J Hyperthermia. 2019;36(1):926-931. doi: 10.1080/02656736.2019.1654619.
To evaluate the outcomes of subsequent pregnancies in patients with a history of cesarean scar pregnancy (CSP) treated with high intensity focused ultrasound (HIFU) followed by ultrasound-guided dilation and curettage (USg-D&C). A retrospective analysis was performed on data collected from 154 patients with CSP who were treated by HIFU followed by USg-D&C in Suining Central Hospital between January 2015 and January 2018. Among them, 28 patients wanted to conceive following treatment. Baseline characteristics, treatment results, intraoperative hemorrhages during USg-D&C, post-curettage serum beta human chorionic gonadotropin (β-hCG) levels and vaginal bleeding were investigated. Subsequent pregnancy outcomes, including intervals between pregnancy and treatment of CSP, complications during pregnancy, and outcomes of newborns were evaluated. All patients with CSP were successfully treated by HIFU combined with USg-D&C. Of the 28 CSP patients who intended to conceive after the treatment, 23 patients (82.14%) successfully conceived. The average interval between conception and HIFU treatment was 18.38 ± 10.04 months. Eighteen patients (78.26%) had an intrauterine pregnancy, in which 12 had delivery by cesarean section, 1 had an ongoing pregnancy, and 5 had an abortion in the first trimester. Among the other 5 women, 3 had tubal ectopic pregnancy and 2 had recurrent CSP. These five patients underwent laparoscopy within the first trimester. HIFU followed by USg-D&C is an effective and safe treatment for patients with CSP who wish to conceive. Prospective multi-center studies with larger sample sizes and longer follow-up periods are needed to compare this treatment with others.
评估既往剖宫产术后子宫瘢痕妊娠（CSP）患者行高强度聚焦超声（HIFU）联合超声引导下清宫术（USg-D&C）治疗后再次妊娠的结局。回顾性分析 2015 年 1 月至 2018 年 1 月在遂宁市中心医院接受 HIFU 联合 USg-D&C 治疗的 154 例 CSP 患者的临床资料，其中 28 例患者治疗后有生育要求。分析患者的一般资料、治疗效果、USg-D&C 术中出血量、清宫术后血β-HCG 水平及阴道流血情况，随访再次妊娠结局，包括 CSP 治疗至妊娠的时间间隔、妊娠期间并发症及新生儿结局。所有患者均成功接受 HIFU 联合 USg-D&C 治疗，28 例有生育要求的 CSP 患者中 23 例（82.14%）成功妊娠，妊娠距 CSP 治疗的时间间隔为 18.38±10.04 个月。18 例（78.26%）获得宫内妊娠，其中 12 例行剖宫产分娩，1 例继续妊娠，5 例孕早期流产；另 5 例中 3 例异位妊娠，2 例再次发生 CSP，均于孕早期行腹腔镜手术治疗。对于有生育要求的 CSP 患者，HIFU 联合 USg-D&C 是一种有效且安全的治疗方法，需要前瞻性多中心研究进一步比较该治疗方法与其他方法的疗效。
