Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China.
Department of Obstetrics and Gynecology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
Reprod Biol Endocrinol. 2024 Jul 18;22(1):84. doi: 10.1186/s12958-024-01256-0.
Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy associated with severe complications, including significant hemorrhage, the potential need for hysterectomy, and life-threatening risks. Currently, two classification methods exist for CSP: Vial (type I and II) and Chinese Expert's Consensus (type I, type II, and type III). However, these methods have limitations in guiding the selection of appropriate treatment plans for CSP. The purpose of this study was to systematically evaluate the effectiveness of various treatments for CSP within our clinic.
Our study included 906 patients with CSP from January 2013 to December 2018. The chi-squared test and logistic analysis were used to compare the clinical characteristics. The median and interquartile range (IQR) was calculated. We also analyzed whether preoperative application of methotrexate (MTX) could improve surgical outcomes and the relevant characteristics of misdiagnosed CSP patients.
There was a significant difference in gestational age, gestational sac diameter, gestational sac width, gestational sac area, remnant myometrial thickness, vaginal bleeding and preoperative hemoglobin levels (p < 0.001) but not in the incidence of residual tissue (p = 0.053). The other factors (intraoperative blood loss, hemoglobin decline, first hemoglobin after operation, total hospital stay, hospital stay after operation, transfusion and duration of catheter drain) were significantly different (p < 0.001). For type I and type I CSP, 39.3% and 40.2% of patients were treated with dilatation and curettage (D&E) under ultrasound, respectively. For type II and type III CSP, 29.9% and 62.7% of patients were treated with laparotomy, respectively. There were no differences in surgical methods, residual tissue and reoperation between the MTX and non-MTX groups (p = 0.20), but liver damage, hospital stay and pain perception were more remarkable in the MTX group. It is noteworthy that 14% of the patients were misdiagnosed with an intrauterine pregnancy. The incidence of misdiagnosis in type II CSP patients was higher than that in type I CSP patients (p < 0.001).
For type I CSP patients, D&E under ultrasound or D&E under hysteroscopy should be recommended. For type III CSP patients, operative resection should be used. It is currently difficult to choose the appropriate treatment methods for type II or type II CSP patients.
剖宫产瘢痕妊娠（CSP）是一种与严重并发症相关的异位妊娠，包括大量出血、需要子宫切除术以及危及生命的风险。目前，CSP 有两种分类方法：Vial（I 型和 II 型）和中国专家共识（I 型、II 型和 III 型）。然而，这些方法在指导 CSP 患者的治疗方案选择方面存在局限性。本研究旨在系统评估我们诊所中各种治疗 CSP 的效果。
我们的研究包括 2013 年 1 月至 2018 年 12 月期间的 906 例 CSP 患者。采用卡方检验和逻辑分析比较临床特征。计算中位数和四分位数间距（IQR）。我们还分析了术前应用甲氨蝶呤（MTX）是否可以改善手术结果以及误诊 CSP 患者的相关特征。
在孕龄、孕囊直径、孕囊宽度、孕囊面积、残留子宫肌层厚度、阴道出血和术前血红蛋白水平方面有显著差异（p < 0.001），但在残留组织发生率方面无差异（p = 0.053）。其他因素（术中出血量、血红蛋白下降量、术后首次血红蛋白、总住院时间、术后住院时间、输血和引流管放置时间）有显著差异（p < 0.001）。对于 I 型和 I 型 CSP，分别有 39.3%和 40.2%的患者在超声引导下接受刮宫术（D&E）治疗。对于 II 型和 III 型 CSP，分别有 29.9%和 62.7%的患者接受剖腹手术治疗。MTX 组和非 MTX 组在手术方法、残留组织和再次手术方面无差异（p = 0.20），但 MTX 组肝损伤、住院时间和疼痛感知更为明显。值得注意的是，有 14%的患者被误诊为宫内妊娠。II 型 CSP 患者的误诊发生率高于 I 型 CSP 患者（p < 0.001）。
对于 I 型 CSP 患者，建议采用超声引导下 D&E 或宫腔镜下 D&E。对于 III 型 CSP 患者，应采用手术切除。目前，对于 II 型或 II 型 CSP 患者，难以选择合适的治疗方法。
