Journal of Shandong University (Health Sciences) ›› 2021, Vol. 59 ›› Issue (1): 40-44.doi: 10.6040/j.issn.1671-7554.0.2020.1058

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Experience in the treatment of 86 cases of type Ⅲ cesarean scar pregnancy

HUO Suxia1, LIU Wei1, WANG Xin2   

  1. 1. Department of Gynecology;
    2. Department of Ultrasound Diagnosis, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2021-01-09

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Abstract: Objective To explore the treatment strategy of type Ⅲ cesarean scar pregnancy(CSP). Methods The records of 86 patients with type Ⅲ CSP treated in our hospital in the last decade were retrospectively reviewed. According to the surgical methods, the patients were divided into three groups. Group A(n=30)underwent curettage after uterine artery embolization, group B(n=18)received hysteroscopic curettage, and group C(n=38)received laparoscopy combined with hysteroscopic curettage and uterine scar repair. The gestational age, diameter of gestational sac, myometrium thickness, preoperative serum β-human chorionic gonadotropin(β-hCG)level, intraoperative blood loss, decrease of postoperative serum β-hCG, hospitalization time and success rate were compared among the three groups. The quantitative data involved multiple groups of one-way ANOVA or nonparametric test, and the classified data were analyzed by Chi-square test. Results There were no significant differences in maternal age, cesarean frequency and interval since the last cesarean section among the three groups(P>0.05). Gestational sac diameter was larger in group A and group C than in group B(F=52.196, P<0.001). Myometrium thickness was lower in group A and group C than in group B(H=42.553, P<0.001). Preoperative serum β-hCG was significantly higher in group A and group C than in group B(H=9.173, P=0.010). The other pairwise comparisons had no statistical significance. The median amount of intraoperative blood loss was higher in group C than in group A and group B(H=17.211, P<0.001). The success rate in groups A, B and C was 86.67%, 88.89% and 97.37%, respectively, with no significant difference(χ2=3.072, P=0.190). The mean decrease of postoperative serum β-hCG in group C was the fastest(H=14.238, P=0.001). Conclusion For type Ⅲ CSP with gestational sac or mass ≤3 cm and scar thickness ≥2 mm, hysteroscopic curettage can be selected. For gestational sac or mass >3 cm and scar thickness <2 mm, laparoscopy combined with hysteroscopic curettage is recommended. Uterine artery embolization can be used as a supplementary treatment when massive bleeding occurs after primary treatment instead of a preventive measure before curettage.

Key words: Cesarean scar pregnancy, Surgical treatment, Uterine artery embolization, Hysteroscopy, Laparoscopy, Uterine scar repair

CLC Number: 

  • R714.1
[1] Timor-Tritsch IE, Monteagudo A, Calì G, et al. Cesarean Scar Pregnancy: Diagnosis and Pathogenesis[J]. Obstet Gynecol Clin North Am, 2019, 46(4): 797-811.
[2] 林蓉, 韦娟冰, 王金华. 29例子宫切口瘢痕妊娠治疗方法的临床观察[J]. 生殖医学杂志, 2017, 26(5): 486-489.
[3] 中华医学会妇产科学分会计划生育学组. 剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J]. 中华妇产科杂志, 2016, 51(8): 568-572.
[4] Glenn TL, Bembry J, Findley AD, et al. Cesarean Scar Ectopic Pregnancy: Current Management Strategies [J]. Obstet Gynecol Surv, 2018, 73(5): 293-302.
[5] Tumenjargal A, Tokue H, Kishi H, et al. Uterine Artery Embolization Combined with Dilation and Curettage for the Treatment of Cesarean Scar Pregnancy: Efficacy and Future Fertility [J]. Cardiovasc Intervent Radiol, 2018, 41(8): 1165-1173.
[6] 康彦君, 班艳丽, 张腾, 等. 子宫瘢痕妊娠实用临床分型及应用价值探讨[J]. 现代妇产科进展, 2019, 28(10): 731-735. KANG Yanjun, BAN Yanli, ZHANG Teng, et al. Practical clinical classification and its application in treatment of cesarean scar pregnancy [J]. Progress in Obstetrics and Gynecology, 2019, 28(10): 731-735.
[7] Gonzalez N, Tulandi T. Cesarean Scar Pregnancy: A Systematic Review [J]. J Minim Invasive Gynecol, 2017, 24(5): 731-738.
[8] 白亮亮, 李甜甜, 李宗明, 等. 刮宫术前行预防性子宫动脉栓塞治疗瘢痕妊娠的必要性[J]. 中国介入影像与治疗学, 2018, 15(1): 47-50. BAI Liangliang, LI Tiantian, LI Zongming, et al. Necessity of prophylactic uterine artery embolization before curettage in treatment of cesarean scar pregnancy [J]. Chinese Journal of Interventional Imaging and Therapy, 2018, 15(1): 47-50.
[9] Zhang G, Li J, Tang J, et al. Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy [J]. BMC Pregnancy Childbirth, 2019, 19(1): 502.
[10] Chen H, Zhou J, Wang H, et al. The Treatment of Cesarean Scar Pregnancy with Uterine Artery Embolization and Curettage as Compared to Transvaginal Hysterotomy [J]. Eur J Obstet Gynecol Reprod Biol, 2017, 214: 44-49.
[11] Keung JJ, Spies JB, Caridi TM. Uterine artery embolization: a review of current concepts [J]. Best Pract Res Clin Obstet Gynaecol, 2018, 46(1): 66-73.
[12] Qian ZD, Weng Y, Du YJ, et al. Management of persistent cesarean scar pregnancy after curettage treatment failure [J]. BMC Pregnancy Childbirth, 2017, 17(1): 208.
[13] 安瑞, 李长东. 剖宫产瘢痕妊娠发病机制及影响因素[J]. 中国计划生育学杂志, 2018, 26(7): 643-646. AN Rui, LI Changdong. Pathogenesis and influencing factors of cesarean scar pregnancy [J]. Chinese Journal of Family Planning, 2018, 26(7): 643-646.
[14] Ying X, Zheng W, Zhao L, et al. Clinical characteristics and salvage management of persistent cesarean scar pregnancy [J]. J Obstet Gynaecol Res, 2017, 43: 1293-1298.
[15] 李旺, 邹凌霄, 潘琼, 等. 剖宫产子宫切口瘢痕缺陷的宫腔镜手术治疗[J]. 中国实用妇科与产科杂志, 2018, 34(8): 865-869. LI Wang, ZOU Lingxiao, PAN Qiong, et al. Hysteroscopic surgery treatment for cesarean scar diverticulum [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2018, 34(8): 865-869.
[16] 王光伟, 刘晓菲, 王丹丹, 等. 选择性子宫动脉栓塞术联合宫腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠67例临床分析[J]. 中华妇产科杂志, 2015, 50(8): 576-580.
[17] Zhang Y, Chen L, Zhou M, et al. Risk factors of persistent cesarean scar pregnancy after dilation and curettage: a matched case-control study [J]. Taiwan J Obstet Gynecol, 2020, 59(2): 237-242.
[18] Qi F, Chai ZY, Liu MM, et al. Type 2 Cesarean Scar Pregnancy Successfully Treated via Hysteroscopy-Assisted Laparoscopy [J]. J Minim Invasive Gynecol, 2019, 26(7): 1273-1281.
[19] Lee CL, Wang CJ, Chao A, et al. Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar [J]. Hum Reprod, 1999, 14(5): 1234-1236.
[20] Qi F, Chai ZY, Liu MM, et al. Type 2 Cesarean Scar Pregnancy Successfully Treated via Hysteroscopy-Assisted Laparoscopy [J]. J Minim Invasive Gynecol, 2019, 26(7): 1273-1281.
[21] Gonzalez N, Tulandi T. Cesarean scar pregnancy: a systematic review [J]. J Minim Invasive Gynecol, 2017, 24(5): 731-738.
[22] Glenn TL,Bembry J,Findley AD,et al.Cesarean scar ectopic pregnancy: current management strategies [J]. Obstet Gynecol Surv, 2018, 73(5): 293-302.
[23] Chai ZY, Zhang SS, Hu XH, et al. Successful Resection of an 11-Week Cesarean Scar Pregnancy With a Combination of Laparoscopy and Hysteroscopy [J]. J Minim Invasive Gynecol, 2018, 25: 320-321.
[24] Maheux-Lacroix S, Li F, Bujold E, et al. Cesarean scar pregnancies: a systematic review of treatment options [J]. J Minim Invasive Gynecol, 2017, 24(6): 915-925.
[25] Wang G, Liu X, Bi F, et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy [J]. Fertil Steril, 2014, 101(5): 1501-1507.
[26] 王珏, 杜琰, 华克勤, 等. 剖宫产术后子宫切口憩室流行病学特征及其影响因素的研究进展[J]. 复旦学报(医学版), 2018, 45(2): 271-276. WANG Jue, DU Yan, HUA Keqin, et al. Research progress of epidemiological characteristics and influencing factors of cesarean scar defect after cesarean section [J]. Fudan University Journal of Medical Sciences, 2018, 45(2): 271-276.
[27] Lu YM, Guo YR, Zhou MY. Indwelling Intrauterine Foley Balloon Catheter for Intraoperative and Postoperative Bleeding in Cesarean Scar Pregnancy [J]. J Minim Invasive Gynecol, 2020, 27(1): 94-99.
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