Wang Yan, Tan Guichun, Cheng Xianghong, Xu Yahui, Xu Fuxia, Qu Pengpeng
Tianjin Medical University, Tianjin, China.
Department of Gynecology, Jinghai Clinical College of Tianjin Medical University, Tianjin, China.
J Obstet Gynaecol Res. 2020 Aug;46(8):1378-1383. doi: 10.1111/jog.14319. Epub 2020 Jun 17.
To analyze whether crossover sign (COS) can help predict the risk of bleeding during surgical evacuation in patients with caesarean scar pregnancy (CSP).
This study retrospectively analyzed the clinical presentations, ultrasound images and treatment outcomes of patients with CSP. The relationship among the gestational sac, caesarean scar and the anterior uterine wall, defined as the COS, was analyzed to predict the risk of severe bleeding during surgical evacuation in these patients. All patients were categorized according to the relationship between the endometrial line and the superior-inferior diameter of the gestational sac into crossover sign-1 and crossover sign-2 groups. The Mann-Whitney U test was used to compare the data with non-normal distribution, and logistic regression analysis was performed to identify the correlates of severe bleeding.
A total of 74 patients were included. In COS-1 group (n = 21), 16 (76.19%) patients suffered heavy bleeding(≥200 mL) during surgical evacuation, while COS-2 group (n = 53) had only 1(11.89%) patient complaint of heavy bleeding (≥200 mL) (P < 0.01). Adverse surgical outcomes were more common in women with COS-1. Logistic regression analysis showed that COS-1 (OR, 7.93; 95% CI, 1.35-46.67) was independently associated with severe bleeding.
COS can help predict who has a higher risk of severe hemorrhage in patients with CSP and guide the clinical treatment selection for optimal management of this condition.
分析交叉征（COS）是否有助于预测剖宫产瘢痕妊娠（CSP）患者手术清宫时的出血风险。
本研究回顾性分析了CSP患者的临床表现、超声图像及治疗结局。分析妊娠囊、剖宫产瘢痕与子宫前壁之间的关系（即交叉征），以预测这些患者手术清宫时严重出血的风险。所有患者根据子宫内膜线与妊娠囊上下径的关系分为交叉征-1组和交叉征-2组。采用Mann-Whitney U检验比较非正态分布的数据，并进行逻辑回归分析以确定严重出血的相关因素。
共纳入74例患者。在交叉征-1组（n = 21）中，16例（76.19%）患者在手术清宫时发生大出血（≥200 mL），而交叉征-2组（n = 53）仅有1例（11.89%）患者主诉大出血（≥200 mL）（P < 0.01）。交叉征-1的女性手术不良结局更为常见。逻辑回归分析显示，交叉征-1（OR，7.93；95% CI，1.35 - 46.67）与严重出血独立相关。
交叉征有助于预测CSP患者严重出血风险较高者，并指导临床治疗选择，以实现对该疾病的最佳管理。
