Obstetrics and Gynaecology Senior House Officer, Palmerston North Hospital, Midcentral District Health Board, Palmerston North.
Obstetrics and Gynaecology Registrar, Palmerston North Hospital, Midcentral District Health Board, Palmerston North.
N Z Med J. 2021 Apr 16;134(1533):61-70.
To evaluate the approach to diagnosis and management of caesarean scar pregnancy (CSP) at a regional New Zealand hospital.
A retrospective case series of ten patients between June 2015 and May 2020. The data review included demographic information, ultrasound findings, human chorionic gonadotropin (HCG) levels, primary and subsequent treatment, outcomes and complications.
Nine women were diagnosed with CSP at a gestational age between four and ten weeks. One of these women was treated twice for two separate CSP within the study period. Treatment varied according to clinical presentation, HCG levels, gestational age, ultrasound findings and patient preference. Two thirds of women were successfully treated with primary management, with one third requiring multiple treatment modalities. We report one severe life-threatening haemorrhage and three cases resulting in hysterectomy. We also show a disproportionate number of Māori women presenting with CSP.
We present a series of ten cases of CSP and demonstrate similar challenges in regional New Zealand to those reported elsewhere. Management is heterogeneous with little guidance from the literature, and primary management was successful in seven out of ten cases. We report a disproportionately high number of cases in Māori women. Our results would support the development of a national register for caesarean scar pregnancy to improve diagnosis and management across New Zealand.
评估新西兰一家地区医院剖宫产术后子宫瘢痕妊娠（CSP）的诊断和治疗方法。
对 2015 年 6 月至 2020 年 5 月期间的 10 例患者进行回顾性病例系列研究。数据回顾包括人口统计学信息、超声检查结果、人绒毛膜促性腺激素（hCG）水平、初次和后续治疗、结局和并发症。
9 名女性被诊断为 CSP，妊娠龄为 4 至 10 周。其中 1 名女性在研究期间两次因两次不同的 CSP 接受治疗。治疗方案根据临床表现、hCG 水平、妊娠龄、超声检查结果和患者意愿而有所不同。三分之二的女性经初次治疗成功，三分之一的女性需要多种治疗方式。我们报告了一例严重的危及生命的出血和 3 例导致子宫切除的病例。我们还显示了 CSP 患者中毛利妇女的比例不成比例地高。
我们报告了 10 例 CSP 病例，结果表明新西兰地区与其他地区报告的 CSP 存在相似的挑战。管理方案存在异质性，文献指导较少，初次治疗在 10 例中有 7 例成功。我们报告毛利妇女的病例比例不成比例地高。我们的研究结果支持建立一个全国性的剖宫产术后子宫瘢痕妊娠登记处，以改善新西兰各地的诊断和管理。
