Journal of Shandong University (Health Sciences) ›› 2023, Vol. 61 ›› Issue (11): 1-10.doi: 10.6040/j.issn.1671-7554.0.2023.0988

• Academic Frontiers •     Next Articles

Expert consensus of practical clinical classification system with optimal surgical strategy for cesarean scar pregnancy

Yanli BAN,Ying Yanli Writing experts: ZHAO,Hua LI,Wei LIU,Fengnian RONG,Shuping ZHAO,Baoxia CUI*()   

  1. Family Planning Branch of Shandong Provincial Medical Association
  • Received:2023-11-06 Online:2023-11-10 Published:2023-12-12
  • Contact: Baoxia CUI E-mail:cuibaoxia@sdu.edu.cn

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Abstract:

Cesarean scar pregnancy (CSP) is a special type of ectopic pregnancy in which a pregnancy sac is implanted at the scar of a previous caesarean section. Without appropriate diagnosis or treatment, it can lead to severe morbidity such as life-threatening massive hemorrhage, and uterine rupture, with subsequent effect of fertility, physical and mental health of patients. Although many different treatment options have been described, there is still no consensus on the optimal surgical treatment strategy. In recent years, treatment of CSP based on classification has drawn more and more attention. The practical clinical classification system with optimal surgical strategy for CSP has been widely validated in Shandong Province, which shows good application value and reliable therapeutic effects. Based on this classification system, and combined with clinical experience and the latest clinical research results, the expert consensus of clinical classification system and surgical strategy for CSP is formulated, aiming to standardize the clinical diagnosis and treatment, and to guide clinical work.

Key words: Cesarean scar pregnancy, Ectopic pregnancy, Clinical classification, Treatment, Expert consensus

CLC Number: 

  • R713.8

Table 1

Clinical classification of cesarean scar pregnancy and recommended optimal surgical treatment strategy"

实用临床分型 前壁肌层厚度 妊娠囊或包块平均直径 推荐的首选手术方式
Ⅰ型 ＞3 mm 无论大小 超声监视下负压吸宫术±宫腔镜手术*
Ⅱ型 ≤3 mm且＞1 mm Ⅱa≤30 mm 超声监视下负压吸宫术+宫腔镜手术*
Ⅱb＞30 mm 腹腔镜监视下负压吸宫术+宫腔镜手术*
必要时腹腔镜下瘢痕缺陷修补术
或经阴道前穹隆切开病灶切除术
Ⅲ型 ≤1 mm Ⅲa≤50 mm 腹腔镜下瘢痕妊娠病灶切除+缺陷修补术+负压吸宫术
或经阴道前穹隆切开病灶切除术
Ⅲb＞50 mm, 或伴有动静脉畸形 子宫动脉栓塞/子宫动脉暂时性阻断后腹腔镜下瘢痕妊娠病灶切除+缺陷修补+负压吸宫术
或开腹瘢痕妊娠病灶切除术+缺陷修补术

Fig.1

Description of new clinical classification system for cesarean scar pregnancy [6] A-C: Type Ⅰ is defined as the implantation of a gestational sac or mass within the cesarean scar, with anterior myometrium thickness greater than 3 mm regardless of the size of the gestational sac or mass; D-F: Type Ⅱa is defined as anterior myometrium thickness between 1 and 3 mm and average diameter of the gestational sac or mass 30 mm or less; G-I: Type Ⅱb is defined as anterior myometrium thickness between 1 and 3 mm and average diameter of the gestational sac or mass greater than 30 mm; J-L: In type Ⅲa, the gestational sac bulges out under the cesarean scar, with anterior myometrium thickness 1 mm or less and average diameter of the gestational sac or mass 50 mm or less; M-O: Type Ⅲb is defined as anterior myometrium thickness 1 mm or less and average diameter of the gestational sac or mass greater than 50 mm."

Fig.2

Strategy of clinical classification system and optimal surgical strategy for cesarean scar pregnancy"

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