Zeng Yuhua, Luo Qiao, Ran Wei, Liu Jiashu, Zhang Chengju, Yong Min
The Affiliated Hospital of North Sichuan Medical College, Department of Gynecology - Nanchong, China.
The Affiliated Hospital of North Sichuan Medical College, Department of Reproductive Medicine - Nanchong, China.
Rev Assoc Med Bras (1992). 2025 Aug 8;71(7):e20241912. doi: 10.1590/1806-9282.20241912. eCollection 2025.
Cesarean scar pregnancy poses significant risks, including uterine scar rupture and increased postpartum hemorrhage. Effective diagnosis and treatment are critical to improving clinical outcomes. This study aimed to analyze the risk factors for cesarean scar pregnancy and evaluate the efficacy and safety of hysteroscopic diagnosis and treatment, providing a theoretical basis for clinical management.
A total of 122 patients with cesarean scar pregnancy, diagnosed via vaginal ultrasound, were included in the study group and treated with hysteroscopic surgery. A total of 90 pregnant women with prior cesarean sections and normal intrauterine pregnancies were selected as the control group.
Logistic regression identified significant cesarean scar pregnancy risk factors: the number of uterine operations, the number of cesarean sections, and a time interval of ≤5 years since the last cesarean (p<0.05). After hysteroscopic treatment, the mean operation time, intraoperative bleeding, and surgical failure rate were 22.31±6.26 min, 57.23±9.12 mL, and 8.03%, respectively. Surgical failure was associated with gestational age, gestational sac position, gestational sac size, diverticulum angle, and blood β-human chorionic gonadotropin levels (p<0.05). Hysteroscopy demonstrated superior diagnostic accuracy over ultrasound for type II and type III cesarean scar pregnancy cases (p<0.05).
Hysteroscopic surgery improves treatment outcomes in cesarean scar pregnancy patients. Key risk factors for surgical failure include gestational age, gestational sac position, gestational sac size, diverticulum angle, and blood β-human chorionic gonadotropin levels. Early identification and management of these factors can enhance clinical outcomes and reduce complications.
剖宫产瘢痕妊娠存在重大风险，包括子宫瘢痕破裂和产后出血增加。有效的诊断和治疗对于改善临床结局至关重要。本研究旨在分析剖宫产瘢痕妊娠的危险因素，并评估宫腔镜诊断和治疗的有效性及安全性，为临床管理提供理论依据。
经阴道超声诊断为剖宫产瘢痕妊娠的122例患者纳入研究组，接受宫腔镜手术治疗。选取90例有剖宫产史且宫内妊娠正常的孕妇作为对照组。
Logistic回归分析确定了剖宫产瘢痕妊娠的显著危险因素：子宫手术次数、剖宫产次数以及末次剖宫产术后间隔时间≤5年（p<0.05）。宫腔镜治疗后，平均手术时间、术中出血量及手术失败率分别为22.31±6.26分钟、57.23±9.12毫升和8.03%。手术失败与孕周、孕囊位置、孕囊大小、憩室角度及血β-人绒毛膜促性腺激素水平有关（p<0.05）。对于Ⅱ型和Ⅲ型剖宫产瘢痕妊娠病例，宫腔镜检查的诊断准确性优于超声检查（p<0.05）。
宫腔镜手术可改善剖宫产瘢痕妊娠患者的治疗效果。手术失败的关键危险因素包括孕周、孕囊位置、孕囊大小、憩室角度及血β-人绒毛膜促性腺激素水平。早期识别和处理这些因素可改善临床结局并减少并发症。
