Cheng Xiao-Ling, Cao Xiao-Yan, Wang Xiao-Qian, Lin Heng-Li, Fang Jin-Chuan, Wang Lin
Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, Shenzhen 518026, Guangdong Province, China.
World J Clin Cases. 2022 Jan 14;10(2):547-553. doi: 10.12998/wjcc.v10.i2.547.
Early scar pregnancy (CSP) in the lower uterine segment after cesarean section is a type of ectopic pregnancy that can cause major complications if left untreated. Transabdominal ultrasound is a common procedure but is influenced by external factors. Thus, intracavitary ultrasound may have better diagnostic efficiency for CSP.
To assess the value of intracavitary ultrasound for diagnosing CSP in the lower uterine segment after cesarean section.
Patients diagnosed with CSP in our hospital from October 2019 to April 2021 were recruited. Transabdominal and intracavitary ultrasound examinations were performed to compare the diagnostic differences for CSP and its types.
Sixty-three patients were diagnosed during the study period. The diagnostic accuracy for CSP was higher in intracavitary ultrasound (96.83%) than in transabdominal ultrasound (84.13%) ( < 0.05). The missed diagnosis and misdiagnosis rates did not differ among the ultrasound types (intra: 0.00% and 3.17%; trans: 4.76% and 11.11%, respectively; > 0.05). For the diagnostic rates for the CSP types, the rates for gestational sac (100.00% 90.48%), heterogeneous mass (93.75% 75.00%), and part of the uterine cavity (80.00% 60.00%) were higher in intracavitary ultrasound than in transabdominal ultrasound, but the difference was not statistically significant ( > 0.05). For gestational sac CSP patients, intracavitary ultrasound showed that the gestational sac was located in the lower uterine segment scar with abundant peripheral blood flow; the distance between the gestational sac and the serosal layer was 2.42 ± 0.50 cm. Intracavitary ultrasound for heterogeneous mass CSP patients indicated that the mass mainly occurred in the lower anterior uterine wall, protruding into the bladder, and was surrounded by abundant internal and peripheral blood flow; the distance between the mass and serosal layer was 1.79 ± 0.30 cm. For CSP type partly located in the uterine cavity, the gestational sac was partly located in the lower uterine cavity and partly in the scar with abundant internal and peripheral blood flow; the distance between the gestational sac and the serosal layer was 2.29 ± 0.28 cm.
Intracavitary ultrasound had a higher diagnostic accuracy and application value for diagnosing CSP than transabdominal ultrasound, with reduced risk of missed diagnoses and misdiagnosis, thereby preventing delayed treatment.
剖宫产术后子宫下段早期瘢痕妊娠（CSP）是一种异位妊娠，如果不治疗可导致严重并发症。经腹超声是一种常用的检查方法，但受外部因素影响。因此，腔内超声对CSP可能具有更好的诊断效率。
评估腔内超声对诊断剖宫产术后子宫下段CSP的价值。
选取2019年10月至2021年4月在我院诊断为CSP的患者。进行经腹和腔内超声检查，比较CSP及其类型的诊断差异。
研究期间共诊断出63例患者。腔内超声对CSP的诊断准确率（96.83%）高于经腹超声（84.13%）（P<0.05）。超声类型之间漏诊率和误诊率无差异（腔内：0.00%和3.17%；经腹：分别为4.76%和11.11%，P>0.05）。对于CSP各类型的诊断率，腔内超声对妊娠囊（100.00%对90.48%）、不均质包块（93.75%对75.00%）和部分位于宫腔内（80.00%对60.00%）的诊断率高于经腹超声，但差异无统计学意义（P>0.05）。对于妊娠囊型CSP患者，腔内超声显示妊娠囊位于子宫下段瘢痕处，周边血流丰富；妊娠囊与浆膜层的距离为2.42±0.50cm。腔内超声对不均质包块型CSP患者显示包块主要位于子宫前壁下段，突向膀胱，内部及周边血流丰富；包块与浆膜层的距离为1.79±0.30cm。对于部分位于宫腔内的CSP类型，妊娠囊部分位于子宫下段宫腔内，部分位于瘢痕处，内部及周边血流丰富；妊娠囊与浆膜层的距离为2.29±0.28cm。
与经腹超声相比，腔内超声对诊断CSP具有更高的诊断准确率和应用价值，降低了漏诊和误诊风险，从而避免延误治疗。
