Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China.
Research Center of Clinical Epidemiology, Peking University Third hospital, Beijing 100191, China.
Reprod Biomed Online. 2020 Aug;41(2):290-299. doi: 10.1016/j.rbmo.2020.03.016. Epub 2020 May 6.
What is the best intervention time and method for patients who are diagnosed with heterotopic caesarean scar pregnancy (HCSP) wishing to preserve intrauterine pregnancy.
Four patients diagnosed with HCSP from January 2014 to May 2019 were enrolled. Because HCSP is rare, data on 27 published cases were extracted to augment the analysis. Clinical characteristics and medical documents related to fetal reduction and subsequent maternal-neonate outcomes were analysed.
The intervention time was significantly earlier in the full-term birth group (6.76 ± 1.05 weeks) compared with pre-term birth group (8.02 ± 1.55 weeks; P = 0.042). The cumulative full-term delivery rate was 91.48% when the intervention was at 6 weeks' gestation and decreased to 42.02% at 8 weeks. The maternal-neonate outcome was similar among the selective fetal reduction and surgical removal groups as was delivery time (34.68 ± 3.12 versus 34.80 ± 6.64 weeks; P = 0.955). In the four cases undergoing selective fetal reduction, the residual mass grew by 1.16-7.07 times compared with the area before reduction. The maximum size of the residual mass was observed at 12-13 weeks and 22-25 weeks.
Most patients with HCSP who choose to keep intrauterine pregnancy will be able to carry the fetus to term. Selective fetal reduction would be the first intervention of choice and should take place immediately after diagnosis. The residual mass after reduction could continue to grow throughout the whole pregnancy, although this should not be considered as an indication for termination. With good supervision and careful management, the pregnancy could be maintained and carried to term.
对于希望保留宫内妊娠的诊断为异位剖宫产瘢痕妊娠（HCSP）的患者，最佳的干预时间和方法是什么。
纳入了 2014 年 1 月至 2019 年 5 月期间被诊断为 HCSP 的 4 例患者。由于 HCSP 较为罕见，因此还提取了 27 例已发表病例的数据来进行补充分析。分析了与胎儿减灭术及随后母婴结局相关的临床特征和病历。
足月产组（6.76 ± 1.05 周）的干预时间明显早于早产组（8.02 ± 1.55 周；P = 0.042）。当干预时间在 6 周妊娠时，完全足月分娩率为 91.48%，当干预时间在 8 周时则降低至 42.02%。选择性胎儿减灭术和手术切除组的母婴结局和分娩时间相似（34.68 ± 3.12 与 34.80 ± 6.64 周；P = 0.955）。在进行选择性胎儿减灭术的 4 例病例中，残留肿块与减灭术前相比增长了 1.16-7.07 倍。残留肿块的最大尺寸在 12-13 周和 22-25 周观察到。
大多数选择保留宫内妊娠的 HCSP 患者都能够将胎儿妊娠至足月。选择性胎儿减灭术将是首选的干预措施，应在诊断后立即进行。减灭术后的残留肿块可能会在整个孕期继续生长，但这不应视为终止妊娠的指征。通过良好的监护和谨慎的管理，可以维持妊娠并妊娠至足月。
