The Third Affiliated Hospital of Guangzhou Medical University and Key Laboratory for Major Obstetric Diseases, Guangzhou, China.
Gynaecological Laboratory, University of Hong Kong, Pok Fu Lam, Hong Kong.
J Obstet Gynaecol Res. 2021 Jun;47(6):2014-2020. doi: 10.1111/jog.14771. Epub 2021 Mar 28.
This study aimed to examine the characteristics, management, and outcomes of delayed diagnosis of cesarean scar pregnancy (CSP) with hemorrhage intra- or postuterine curettage for early pregnancy termination.
The retrospective study, cases were identified from the interrogation of the hospital database and clinical data including the success rate of different treatments, vaginal bleeding time, abnormal beta-human chorionic gonadotropin (β-hCG) time, and menstrual recovery time, preservation of uterus were analyzed.
Medical records of 80 confirmed CSP cases with dilation and curettage (D&C) as primary treatment were analyzed; among them, 22 were treated with uterine arterial embolization (UAE) + methotrexate (MTX); 32 with UAE + surgery; 26 with only surgery or resection and repair. Treatment with UAE had less intraoperative blood loss (p < 0.05). UAE + surgery treatment had the highest success rate (96.8%, p < 0.05), the least vaginal bleeding duration after treatment (11.9 ± 9.6 days, p < 0.05), and least β-hCG normalization time (17.4 ± 7.8 days, p < 0.05).
UAE + surgery treatment is a favorable and effective option to control massive hemorrhage intra- or post-uterine curettage for early CSP termination.
本研究旨在探讨经子宫内或刮宫术后早期妊娠终止伴出血的剖宫产瘢痕妊娠（CSP）延迟诊断的特征、处理方法和结局。
回顾性研究，通过医院数据库和临床数据查询确定病例，包括不同治疗方法的成功率、阴道出血时间、异常β-人绒毛膜促性腺激素（β-hCG）时间和月经恢复时间、子宫保留情况。
分析了 80 例经扩张刮宫术（D&C）作为主要治疗的确诊 CSP 患者的病历记录；其中 22 例采用子宫动脉栓塞术（UAE）+甲氨蝶呤（MTX）治疗；32 例采用 UAE+手术治疗；26 例仅采用手术或切除和修复治疗。UAE 治疗术中出血量较少（p<0.05）。UAE+手术治疗成功率最高（96.8%，p<0.05），治疗后阴道出血持续时间最短（11.9±9.6 天，p<0.05），β-hCG 正常化时间最短（17.4±7.8 天，p<0.05）。
UAE+手术治疗是控制早期 CSP 终止伴子宫内或刮宫术后大出血的一种有利且有效的选择。
