Tarafdari Azadeh, Hadizadeh Alireza, Irandoost Elnaz, Borna Sedigheh, Ghamari Azin, Ghotbizadeh Vahdani Fahimeh
Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, 14197-33147 Iran.
Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Center Institute, Tehran University of Medical Sciences, Tehran, Iran.
J Obstet Gynaecol India. 2024 Feb;74(1):71-79. doi: 10.1007/s13224-023-01846-9. Epub 2024 Jan 5.
Being considered a life-threatening condition, cesarean scar pregnancy (CSP) leads to loss of fertility, severe bleeding, and even maternal mortality. We intended to assess the effect of double-balloon cervical ripening catheter insertion on CSP termination before nine weeks of gestation.
All participants were diagnosed CSP by abdominal and transvaginal ultrasound The cases were treated with a sterile, double-balloon cervical ripening catheter inserted with real-time transabdominal ultrasound guidance and removed three days later. The control group consisted of patients treated with systemic methotrexate with or without fetal reduction.
Thirty-five patients were eligible for double-balloon ripening and 32 for MTX therapy; the treatment in cases failed in five of the patients. Success rate difference between two methods was insignificant (Pearson Chi-square: 0.383, -value: 0.536). There were significant differences regarding the time to normal menstruation (OR: 1.303) and the thickness of the myometrium after surgery (OR: 4.721), but there was no significant difference in the time resolve of either -HCG or residue of pregnancy.
Double-balloon cervical ripening insertion yields acceptable results for terminating CSP. This strategy does not cause bleeding and even prevents it with its tamponade properties. Additionally, this treatment is minimally invasive simple with low morbidity.
剖宫产瘢痕妊娠（CSP）被视为一种危及生命的疾病，可导致生育能力丧失、严重出血，甚至孕产妇死亡。我们旨在评估在妊娠9周前插入双球囊宫颈成熟导管对终止CSP的效果。
所有参与者均通过腹部和经阴道超声诊断为CSP。病例在实时经腹超声引导下插入无菌双球囊宫颈成熟导管进行治疗，并在三天后取出。对照组由接受全身甲氨蝶呤治疗（有或无减胎）的患者组成。
35例患者适合双球囊成熟治疗，32例适合甲氨蝶呤治疗；5例患者治疗失败。两种方法的成功率差异不显著（Pearson卡方检验：0.383，P值：0.536）。月经恢复正常的时间（OR：1.303）和术后子宫肌层厚度（OR：4.721）存在显著差异，但血β-HCG下降时间或妊娠物残留情况无显著差异。
插入双球囊宫颈成熟导管终止CSP效果良好。该策略不会引起出血，甚至因其填塞作用可预防出血。此外，这种治疗微创、操作简单且发病率低。
